Surgical cutting and stapling device

ABSTRACT

The present invention, in accordance with various embodiments thereof, relates to a surgical device for at least one of cutting and stapling a section of tissue. The surgical device includes a housing including at least two drivers. The surgical device also includes an anvil mechanically attachable to the housing and moveable relative to the housing between an open position and a closed position. The first driver operates to move the anvil relative to the housing to an intermediate position between the open position and the closed position. The second driver operates to move at least a portion of the housing relative to the anvil between the intermediate position and the closed position.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application relates to U.S. patent application Ser. No. 09/324,452,filed on Jun. 2, 1999 and issued as U.S. Pat. No. 6,443,973, U.S.application Ser. No. 09/723,715, filed on Nov. 28, 2000, U.S.application Ser. No. 09/324,451, filed on Jun. 2, 1999 and issued asU.S. Pat. No. 6,315,184, U.S. application Ser. No. 09/351,534, filed onJul. 12, 1999 and issued as U.S. Pat. No. 6,264,087, U.S. applicationSer. No. 09/510,923, filed on Feb. 22, 2000 and issued as U.S. Pat. No.6,517,565, U.S. application Ser. No. 09/510,927, filed on Feb. 22, 2000,U.S. Application Ser. No. 09/510,932, filed on Feb. 22, 2000 and issuedas U.S. Pat. No. 6,491,201, U.S. application Ser. No. 09/836,781, filedon Apr. 17, 2001, U.S. patent application Ser. No. 09/887,789, filed onJul. 22, 2001, each of which is expressly incorporated herein in itsentirety by reference.

FIELD OF THE INVENTION

The present invention relates to an electromechanical surgical system,and more particularly to a surgical attachment of an electromechanicalsurgical system for clamping, cutting and stapling tissue in the body ofa patient.

BACKGROUND INFORMATION

There are many surgical procedures that require a surgical instrument tobe introduced into an orifice of a body. One example of such is asurgical procedure to resect a cancerous or anomalous tissue from anoral passage by the introduction, e.g., insertion, of a circularclamping, cutting and stapling instrument via a patient's oral cavity.

One of the problems experienced during surgical procedures of this typeis that the orifice of the body may be damaged when the surgicalinstrument is being introduced, or has been introduced, into theorifice. This is particularly problematic when the orifice into whichthe surgical device is being introduced includes fragile tissue that iseasily damaged when contacted, e.g., the tissues of the oral cavity.Another problem experienced during surgical procedures of this type isthat the surgical instrument may be damaged when the surgical instrumentis being introduced, or has been introduced, into the orifice. It may beparticularly important to avoid damage to the surgical device, since apatient may also be harmed if the surgical device functions improperly.

While significant advances have been made in miniaturizing surgicalinstruments, conventional surgical instruments are typically not able tobe employed within a relatively small orifice or passage of a patient,such an oral passage. Thus, conventional surgical devices and proceduresstill risk damage to one or both of the surgical device and theorifice/passage.

Thus, there is a need for a device that minimizes the likelihood ofdamage to one or both of a surgical device and an orifice or passage ofa patient, e.g., an oral passage, when the surgical device is introducedinto the orifice.

SUMMARY OF THE INVENTION

The present invention, in accordance with various embodiments thereof,relates to a surgical device for at least one of cutting and stapling asection of tissue. The surgical device includes a housing including atleast two drivers. The surgical device also includes an anvilmechanically attachable to the housing and moveable relative to thehousing between an open position and a closed position. The first driveroperates to move the anvil relative to the housing to an intermediateposition between the open position and the closed position. The seconddriver operates to move at least a portion of the housing relative tothe anvil between the intermediate position and the closed position.

Advantageously, the anvil and the housing define first and secondclamping faces, respectively. When the anvil is in the closed position,the surgical device is configured to clamp a section of tissue betweenthe first clamping face of the anvil and the second clamping face of thehousing. The housing may include a cutting element configured to bedriven between a retracted position and an extended position by thesecond driver. The housing may also include a stapling elementconfigured to be driven between a retracted position and an extendedposition by the second driver. The stapling element includes a staplecartridge that is configured to move axially within the housing betweena retracted position and an extended position by the second driver, anda staple pusher configured to push staples that are stored withinrespective staple slots of the staple cartridge out of the staple slotsand into staple guides in the anvil.

The present invention, in accordance with various embodiments thereof,also relates to a surgical device for stapling a section of tissue. Thesurgical device includes a staple pusher and a housing configured tostore staples. The housing is selectively moveable relative to thestaple pusher. The surgical device also includes an anvil moveablerelative to the staple pusher and the housing. Movement of the anvilcauses the housing to move relative to the staple pusher. The anvil maybe moveable relative to the staple pusher between a first position, inwhich the anvil is spaced apart from a clamping surface of the housing,and a second position, in which the anvil contacts the clamping surfaceof the housing. Furthermore, the anvil may be moveable relative to thestaple pusher between the second position and a third position, in whichthe staples stored in the housing are pushed out of the housing by thestaple pusher to be closed against the anvil. In one embodiment, thehousing is connected to the staple pusher by a shear pin, wherein theshear pin is configured to shear when, by the movement of the anvilbetween the second and the third position, the anvil applies apredetermined amount of pressure on the clamping surface of the housing.

The present invention, in accordance with various embodiments thereof,also relates to a surgical device for cutting a section of tissue. Thesurgical device includes a cutting element and a housing having aclamping surface. The housing is selectively moveable relative to thecutting element. The surgical device also includes an anvil moveablerelative to the cutting element and the housing. Movement of the anvilcauses the housing to move relative to the cutting element. The anvilmay be moveable relative to the cutting element between a firstposition, in which the anvil is spaced apart from a clamping surface ofthe housing, and a second position, in which the anvil contacts theclamping surface of the housing. Furthermore, the anvil may be moveablerelative to the cutting element between the second position and a thirdposition, in which the cutting element is brought into contact with theanvil. In one embodiment, the housing is connected to the cuttingelement by a shear pin, which is configured to shear when, by themovement of the anvil between the second and the third position, theanvil applies a predetermined amount of pressure on the clamping surfaceof the housing.

The present invention, in accordance with various embodiments thereof,also relates to a surgical device for at least one of cutting andstapling a section of tissue. The surgical device includes a housingforming a first clamping surface. The surgical device also includes ananvil mechanically attachable and moveable relative to the housing alongan axis between an extended position and a retracted position. The anvilforms a second clamping surface. At least a portion of the first andsecond clamping surfaces are non-perpendicular relative to the axis.Preferably, when the anvil is in the closed position, the surgicaldevice is configured to clamp a section of tissue between the first andsecond clamping faces. Furthermore, the first and second clamping facesmay be parallel relative to each other. A first driver may be employedto move the anvil relative to the housing. A second driver may also beemployed, wherein the housing includes a cutting element configured tobe driven between a retracted position and an extended position by thesecond driver. In addition, the housing may include a stapling elementconfigured to be driven between a retracted position and an extendedposition by the second driver.

The present invention, in accordance with various embodiments thereof,also relates to a surgical device for at least one of cutting andstapling a section of tissue. The surgical device also includes ahousing including a stapling element. The stapling element includes astaple cartridge defining a plurality of slots and staples stored withinthe slots. The stapling element also includes a staple pusher havingstaple pusher fingers aligned with the plurality of slots. The surgicaldevice also includes a driver configured to move the staple cartridgeand the staple pusher together between a retracted position and anintermediate position. At the intermediate position, the driver movesthe staple pusher relative to the staple cartridge to an extendedposition. The surgical device may also include an interference elementthat is configured to maintain the relative position of the staplecartridge and the staple pusher when the driver moves the staplecartridge and the staple pusher together between the retracted positionand the intermediate position. The intermediate position may be aposition at which the staple cartridge sufficiently clamps a section oftissue or a position at which the staple cartridge is axially locked inposition relative to the housing. The interference element may be afrangible component. Alternatively, the interference element may beconnected to the staple pusher and may include a radially extending ribthat maintains contact with a portion of the staple cartridge up to apredetermined pressure. The surgical device may also include a cuttingelement, e.g., a blade, wherein the radially extending rib of theinterference element contacts an oppositely-disposed, radially extendingrib of the staple cartridge and the blade.

The present invention, in accordance with various embodiments thereof,also relates to a surgical device for at least one of cutting andstapling a section of tissue. The surgical device may include a housing.The surgical device may also include a staple cartridge positioned at adistal end of the housing and defining a plurality of slots and staplesstored within the slots. The surgical device may also include a staplepusher positioned proximal to the staple cartridge and having aplurality of staple pusher fingers aligned with the plurality of slots.The surgical device may also include a pusher element positionedproximal to the staple pusher and configured to be simultaneouslyrotated within the housing and distally advanced relative to the staplecartridge. The pusher element has a cam element extending toward thestaple pusher such that the cam element sequentially pushes against theplurality of staple pusher fingers. The pusher element may be keyed to arotatable member that extends longitudinally towards the staplecartridge, such as a neck portion of a spider screw element. Thesurgical device may also include a nut positioned proximally relative tothe pusher element, the nut having an internally threaded bore, whereinthe internally threaded bore of the nut is in threaded engagement withthe rotatable member.

The present invention, in accordance with various embodiments thereof,also relates to a sleeve for facilitating the insertion of a surgicaldevice into one of an orifice and a passage of a patient, the surgicaldevice having a distal end defining a cross-section. The surgical devicemay include a first portion configured to cover at least a portion ofthe surgical device. The surgical device may also include at least oneclosure element selectively moveable between an insertion position, inwhich the closure element(s) tapers to a cross-section that is smallerthan the cross-section of the distal end of the surgical device, and aretracted position, in which the surgical device is configured toperform, through the closure elements, a surgical operation in one ofthe orifice and the passage of the patient.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is a perspective view of an electro-mechanical surgical system,according to one embodiment of the present invention.

FIG. 2 is a perspective view of a remote power console, according to oneembodiment of the present invention.

FIG. 3 is a side elevational view, partially in section, of a flexibleshaft of the electro-mechanical surgical system illustrated in FIG. 1.

FIG. 4 is a cross-sectional view of the flexible shaft taken along theline 4-4 shown in FIG. 3.

FIG. 5( a) is a rear end view of a first coupling of the flexible shaftillustrated in FIG. 3.

FIG. 5( b) is a front end view of a second coupling of the flexibleshaft illustrated in FIG. 3.

FIG. 6( a) is a schematic view illustrating a motor arrangement of theelectro-mechanical surgical system illustrated in FIG. 1.

FIG. 6( b) is a schematic view of the electro-mechanical surgical systemillustrated in FIG. 1.

FIG. 6( c) is a schematic view of an encoder of the flexible shaftillustrated in FIGS. 3 and 4.

FIG. 6( d) is a schematic view of a memory device, according to oneembodiment of the present invention. FIG. 6( e) is a schematic view of awireless RCU, according to one embodiment of the present invention. FIG.6( f) is a schematic view of a wired RCU, according to one embodiment ofthe present invention.

FIG. 7( a) is a front perspective view of a handle portion, according toone embodiment of the present invention.

FIG. 7( b) is a rear perspective view of the handle portion shown inFIG. 7( a).

FIG. 7( c) is an exploded front perspective view of the handle portionshown in FIG. 7( a).

FIG. 7( d) is a top view of the handle portion illustrated in FIG. 7(a).

FIG. 7( e) is a side cross-sectional view of the handle portionillustrated in FIG. 7( d) taken along the lines A-A.

FIG. 7( f) is a side cross-sectional view of the handle portionillustrated in FIG. 7( d) taken along the lines B-B.

FIG. 8 is a perspective view of a cutting and stapling component in anextended position, according to one embodiment of the present invention.

FIG. 9 is a perspective view that illustrates a cutting and staplingcomponent in a partially closed, according to one embodiment of thepresent invention.

FIG. 10( a) is a perspective view that illustrates the components of ananvil assembly, according to one embodiment of the present invention.

FIG. 10( b) is a perspective view that illustrates some of thecomponents of the staple and blade portion in an exploded condition,according to one embodiment of the present invention.

FIG. 10( c) is a perspective view that illustrates the remainingcomponents of the staple and blade portion in an exploded condition,according to one embodiment of the present invention.

FIG. 11( a) is a top, cross-sectional view that illustrates the cuttingand stapling component, according to one embodiment of the presentinvention.

FIG. 11( b) is a side, cross-sectional view that illustrate the cuttingand stapling component, according to one embodiment of the presentinvention.

FIG. 12( a) is a perspective view of a cutting and stapling component,according to one embodiment of the present invention.

FIGS. 12( b) and 12(c) are side cross-sectional views that illustrateadditional features of a cable extension element, according to oneembodiment of the present invention.

FIGS. 13( a) to 13(c) illustrate a handle portion, according to anotherembodiment of the present invention.

FIG. 14( a) is a front perspective view that illustrates a cutting andstapling component in an assembled and partially closed position,according to another embodiment of the present invention.

FIG. 14( b) is a rear perspective view that illustrates the cutting andstapling component shown in FIG. 14( a), in an assembled and partiallyclosed position.

FIG. 14( c) is a side view that illustrates the cutting and staplingcomponent shown in FIG. 14( a), in an assembled and partially closedposition.

FIG. 14( d) is a rear view that illustrates the cutting and staplingcomponent shown in FIG. 14( a), in an assembled and partially closedposition.

FIG. 15( a) is a front exploded view that illustrates the components ofan anvil assembly, according to another embodiment of the presentinvention.

FIG. 15( b) is an exploded, perspective view that illustrates some ofthe components of the staple and blade portion shown in FIG. 15( a).

FIG. 15( c) is an exploded, perspective view that illustrates theremaining components of the staple and blade portion shown in FIG. 15(a).

FIG. 15( d) is an assembled, side cross-sectional view that illustratessome of the components of the staple and blade portion shown in FIG. 15(a).

FIG. 16 is a side cross-sectional view that illustrates schematicallysome components of a surgical attachment, in accordance with anotherembodiment of the present invention.

FIG. 17 is a side cross-sectional view that illustrates schematicallysome components of a surgical attachment, in accordance with anotherembodiment of the present invention.

FIG. 18( a) is an exploded, perspective view that illustrates some ofthe components of a staple and blade portion, according to anotherembodiment of the present invention.

FIG. 18( b) is an assembled, side cross-sectional view that illustratesthe components of the staple and blade portion shown in FIG. 18( a).

FIG. 19( a) is an exploded, perspective view of a sleeve that isconfigured to cover a surgical device, according to one embodiment ofthe present invention.

FIG. 19( b) is a side cross-sectional view of a portion of the sleeveshown in FIG. 19( a) in a closed position.

FIG. 19( c) illustrates the closure elements of the sleeve shown in FIG.19( a) in the open position.

FIG. 19( d) is a perspective view of a sleeve that is configured tocover a surgical device in an insertion position, according to anotherembodiment of the present invention.

FIG. 19( e) is a perspective view of the sleeve shown in FIG. 19( d) ina retracted position.

DETAILED DESCRIPTION

The present invention is directed to an electro-mechanical surgicalsystem. FIG. 1 is a perspective view of an electro-mechanical surgicalsystem 10 according to one embodiment of the present invention.

As shown in FIG. 1, the electro-mechanical surgical system 10 includes aremote power console 12 having a flexible shaft 20 extending therefrom.The flexible shaft 20 includes at least a first rotatable drive shaft 30and a second rotatable drive shaft 32. Additional details of the remotepower console 12 are described and shown in connection with, e.g., FIG.2. Additional details of the flexible shaft 20 are described and shownin connection with, e.g., FIGS. 3 to 6.

Attached, or attachable, to a coupling 26 at the distal end 24 of theflexible cable 20 is a surgical attachment 100. The surgical attachment100 is configured to perform a surgical operation. For the purposes ofexample only, the surgical attachments are described hereinbelow asbeing circular clamping, cutting and stapling devices that areconfigured to perform, e.g., an anastomosis procedure. However, itshould be recognized that the surgical attachments may be any suitabletype of surgical device. Furthermore, for the purposes of example only,the surgical attachments described hereinbelow are described as beingemployed within an oral passage of a patient. However, it should berecognized that the surgical attachments may be employed within any typeof orifice or passage of a patient. Advantageously, the surgicalattachments described hereinbelow have a relatively smallcross-sectional area, thereby facilitating its passage into, e.g., theoral passages, of a patient.

The surgical attachment 100 may include a handle portion 102. A proximalend 102 a of the handle portion 102 is attachable to the coupling 26 atthe distal end 24 of the flexible cable 20. The surgical attachment 100may also include a flexible shaft 104, through which extends at least afirst drive shaft 104 a and a second drive shaft 104 b. A distal end 102b of the handle portion 102 is attachable to a proximal end 104 a of theflexible shaft 104. The flexible shaft 104 may be formed of atissue-compatible, sterilizable elastomeric material. Preferably, theflexible shaft 104 may be formed of a material that is autoclavable. Inaddition, the flexible shaft 104 may be formed of a material having ahigh or relatively high lubricity. For instance, the flexible shaft 104may be formed of a material such as Teflon™ (i.e., a fluoropolymer,e.g., polytetrafluoroethylene—“PTFE”), silicone, a Teflon™/siliconecombination, such as, for example, SIL-KORE™ (made by W.L. Gore &Associates), “EPTFE”, e.g., expanded teflon, etc. Other suitablematerials and sealing arrangements that may be employed are described infurther detail in Applicants' co-pending U.S. patent application Ser.No. 10/099,634, filed on Mar. 15, 2002, which is expressly incorporatedherein by reference in its entirety.

The surgical attachment 100 may also include cutting and staplingcomponent 103. A distal end 104 b of the flexible shaft 104 is attachedor attachable to a proximal end 103 a of the cutting and staplingcomponent 103. One example embodiment of the cutting and staplingcomponent 103 is illustrated in FIGS. 8 to 12( c). As shown in FIG. 8,the cutting and stapling component 103 includes an staple and bladeportion 106. Extending in an axial direction through a centrallydisposed opening of the staple and blade portion 106 is a trocar shaft108, e.g., a cable that may be flexible. Disposed at a distal end 108 aof the trocar shaft 108 is a trocar 110. The trocar 110 is configured toengage an anvil assembly 112. The surgical attachment 100 is configuredsuch that the anvil assembly 112 may be selectively moved, e.g.,extended and retracted, relative to the staple and blade portion 106, asset forth more fully below.

Referring to FIG. 2, there is seen a perspective view of the remotepower console 12 and the flexible shaft 20 of the electro-mechanicalsurgical system 10, according to an example embodiment of the presentinvention. The remote power console 12 may include a housing 14 having afront panel 15. Mounted on front panel 15 are a display device 16 andindicators 18 a, 18 b, which are more fully described hereinbelow. Theflexible shaft 20 may extend from the housing 14 and may be detachablysecured thereto via a first coupling 22. The distal end 24 of theflexible shaft 20 may include a second coupling, for instance coupling26, adapted to detachably secure the surgical attachment 100 to thedistal end 24 of the flexible shaft 20.

Referring to FIG. 3, there is seen a side view, partially in section, ofthe flexible shaft 20. According to one embodiment, the flexible shaft20 includes a tubular sheath 28, which may include a coating or othersealing arrangement to provide a fluid-tight seal between the interiorchannel 40 thereof and the environment. The sheath 28 may be formed of atissue-compatible, sterilizable elastomeric material such as thematerials enumerated above in connection with flexible shaft 104. Inaddition, the sheath 28 may also be formed of a material that isautoclavable. Disposed within the interior channel 40 of the flexibleshaft 20, and extending along the entire length thereof, are the firstrotatable drive shaft 30 and the second rotatable drive shaft 32, aswell as a first steering cable 34, a second steering cable 35, a thirdsteering cable 36, a fourth steering cable 37 and a data transfer cable38. FIG. 4 is a cross-sectional view of the flexible shaft 20 takenalong the line 4-4 shown in FIG. 3 and further illustrates the severalcables 30, 32, 34, 35, 36, 37, 38. Each distal end of the steeringcables 34, 35, 36, 37 is affixed to the distal end 24 of the flexibleshaft 20. Each of the several cables 30, 32, 34, 35, 36, 37, 38 may becontained within a respective sheath.

The first rotatable drive shaft 30 and the second rotatable drive shaft32 may be configured, for example, as highly flexible drive shafts, suchas, for example, braided or helical drive cables. It should beunderstood that such highly flexible drive cables have limited torquetransmission characteristics and capabilities. It should also beunderstood that the surgical attachment 100 illustrated in FIG. 1 anddescribed hereinbelow, may require a higher torque input than the torquetransmittable by the first and second rotatable drive shafts 30, 32. Thefirst and second rotatable drive shafts 30, 32 may thus be configured totransmit low torque but high speed, the high speed/low torque beingconverted to low speed/high torque by gearing arrangements disposed, forexample, at the distal end 24 and/or a proximal end 20 a of the driveflexible shaft 20, in the surgical attachment 100 and/or in the remotepower console 12. It should be appreciated that such gearingarrangement(s) may be provided at any suitable location along the powertrain between the motors disposed in the housing 14 and the surgicalattachment 100 that is detachably attachable to the flexible shaft 20.Such gearing arrangement(s) may include, for example, a spur geararrangement, a planetary gear arrangement, a harmonic gear arrangement,cycloidal drive arrangement, an epicyclic gear arrangement, etc.

Referring now to FIG. 5( a), there is seen a rear end view of the firstcoupling 22. The first coupling 22 includes a first connector 44, asecond connector 48, a third connector 52 and a fourth connector 56,each rotatably secured to the first coupling 22. Each of the connectors44, 48, 52, 56 includes a respective recess 46, 50, 54, 58. As shown inFIG. 5( a), each recess 46, 50, 54, 58 may be hexagonally shaped. Itshould be appreciated, however, that the recesses 46, 50, 54, 58 mayhave any shape and configuration to non-rotatably couple and rigidlyattach the connectors 44, 48, 52, 56 to respective drive shafts of themotor arrangement contained within the housing 12, as more fullydescribed below. It should be appreciated that complementary projectionsmay be provided on respective drive shafts of the motor arrangement tothereby drive the drive elements of the flexible shaft 20 as describedbelow. It should also be appreciated that the recesses may be providedon the drive shafts and complementary projections may be provided on theconnectors 44, 48, 52, 56. Any other coupling arrangement configured tonon-rotatably and releasably couple the connectors 44, 48, 52, 56 andthe drive shafts of the motor arrangement may be provided.

One of the connectors 44, 48, 52, 56 is non-rotatably secured to thefirst rotatable drive shaft 30, and another one of the connectors 44,48, 52, 56 is non-rotatably secured to the second rotatable drive shaft32. The remaining two of the connectors 44, 48, 52, 56 engage withtransmission elements configured to apply tensile forces on the steeringcables 34, 35, 36, 37 to thereby steer the distal end 20 b of theflexible shaft 20. The data transfer cable 38 is electrically andlogically connected with a data connector 60. The data connector 60includes, for example, electrical contacts 62, corresponding to andequal in number to the number of individual wires contained in the datacable 38. The first coupling 22 includes a key structure 42 to properlyorient the first coupling 22 to a mating and complementary couplingarrangement disposed on the remote power console 12. Such key structure42 may be provided on either one, or both, of the first coupling 22 andthe mating and complementary coupling arrangement disposed on the remotepower console 12. The first coupling 22 may include a quick-connect typeconnector, which may use, for example, a simple pushing motion to engagethe first coupling 22 to the housing 12. Seals may be provided inconjunction with any of the several connectors 44, 48, 52, 56, 60 toprovide a fluid-tight seal between the interior of the first coupling 22and the environment.

Referring now to FIG. 5( b), there is seen a front end view of thesecond coupling 26 of the flexible shaft 20. The second coupling 26includes a first connector 66 and a second connector 68, each beingrotatably secured to the second coupling 26 and each being non-rotatablysecured to a distal end of a respective one of the first and secondrotatable drive shafts 30, 32. A quick-connect type fitting 64 isprovided on the second coupling 26 for detachably securing the surgicalattachment 100 thereto. The quick-connect type fitting 64 may be, forexample, a rotary quick-connect type fitting, a bayonet type fitting,etc. A key structure 74 is provided on the second coupling 26 forproperly aligning the surgical instrument or attachment to the secondcoupling 26. The key structure 74 or other arrangement for properlyaligning the surgical attachment 100 to the flexible shaft 20 may beprovided on either one, or both, of the second coupling 26 and thesurgical attachment 100. In addition, the quick-connect type fitting maybe provided on the surgical attachment 100. A data connector 70, havingelectrical contacts 72, is also provided in the second coupling 26. Likethe data connector 60 of the first coupling 22, the data connector 70 ofthe second coupling 26 includes contacts 72 electrically and logicallyconnected to the respective wires of the data transfer cable 38 and thecontacts 62 of the data connector 60. Seals may be provided inconjunction with the connectors 66, 68, 70 to provide a fluid-tight sealbetween the interior of second coupling 26 and the environment.

Disposed within housing 14 of the remote power console 12 areelectro-mechanical driver elements configured to drive the drive shafts30, 32 and the steering cables 34, 35, 36, 37 to thereby operate theelectro-mechanical surgical system 10 and the surgical attachment 100attached to the second coupling 26. In the example embodimentillustrated schematically in FIG. 6( a), five electric motors 76, 80,84, 90, 96, each operating via a power source, may be disposed in theremote power console 12. It should be appreciated, however, that anyappropriate number of motors may be provided, and the motors may operatevia battery power, line current, a DC power supply, an electronicallycontrolled DC power supply, etc. It should also be appreciated that themotors may be connected to a DC power supply, which is in turn connectedto line current and which supplies the operating current to the motors.

FIG. 6( a) illustrates schematically one possible arrangement of motors.An output shaft 78 of a first motor 76 engages with the first connector44 of the first coupling 22 when the first coupling 22, and, therefore,flexible shaft 20, is engaged with the housing 14 to thereby drive thefirst drive shaft 30 and first connector 66 of second coupling 26.Similarly, an output shaft 82 of a second motor 80 engages the secondconnector 48 of first coupling 22 when first coupling 22, and,therefore, flexible shaft 20 is engaged with the housing 14 to therebydrive the second drive shaft 32 and second connector 68 of secondcoupling 26. An output shaft 86 of a third motor 84 engages the thirdconnector 52 of the first coupling 22 when the first coupling 22, and,therefore, flexible shaft 20, is engaged with the housing 14 to therebydrive the first and second steering cables 34, 35 via a first pulleyarrangement 88. An output shaft 92 of a fourth motor 90 engages thefourth connector 56 of the first coupling 22 when the first coupling 22,and, therefore, flexible shaft 20, is engaged with the housing 14 tothereby drive the third and fourth steering cables 36, 37 via a secondpulley arrangement 94. The third and fourth motors 84, 90 may be securedon a carriage 100, which is selectively movable via an output shaft 98of a fifth motor 96 between a first position and a second position toselectively engage and disengage the third and fourth motors 84, 90 withthe respective pulley arrangement 88, 94 to thereby permit the flexibleshaft 20 to become taut and steerable or limp as necessary. It Should beappreciated that other mechanical, electrical or electro-mechanicalmechanisms may be used to selectively engage and disengage the steeringmechanism. The motors may be arranged and configured as described, forexample, in U.S. patent application Ser. No. 09/510,923, entitled “ACarriage Assembly for Controlling a Steering Wire Mechanism Within aFlexible Shaft,” which is expressly incorporated herein in its entiretyby reference thereto.

It should be appreciated, that any one or more of the motors 76, 80, 84,90, 96 may be high-speed/low-torque motors or low-speed/high-torquemotors. As indicated above, the first rotatable drive shaft 30 and thesecond rotatable drive shaft 32 may be configured to transmit high speedand low torque. Thus, the first motor 76 and the second motor 80 may beconfigured as high-speed/low-torque motors. Alternatively, the firstmotor 76 and the second motor 80 may be configured aslow-speed/high-torque motors with a torque-reducing/speed-increasinggear arrangement disposed between the first motor 76 and the secondmotor 80 and a respective one of the first rotatable drive shaft 30 andthe second rotatable drive shaft 32. Suchtorque-reducing/speed-increasing gear arrangement may include, forexample, a spur gear arrangement, a planetary gear arrangement, aharmonic gear arrangement, cycloidal drive arrangement, an epicyclicgear arrangement, etc. It should be appreciated that any such geararrangement may be disposed within the remote power console 12 or in theproximal end of the flexible shaft 20, such as, for example, in thefirst coupling 22. It should be appreciated that the gear arrangement(s)are provided at the distal and/or proximal ends of the first rotatabledrive shaft 30 and/or the second rotatable drive shaft 32 to preventwindup and breakage thereof.

Referring now to FIG. 6( b), there is seen a schematic view of theelectro-mechanical surgical system 10. A controller 1122 is provided inthe housing 14 of the remote power console 12 and is configured tocontrol all functions and operations of the electro-mechanical surgicalsystem 10 and the surgical attachment 100 attached to the flexible shaft20. A memory unit 1130 is provided and may include memory devices, suchas, a ROM component 1132 and/or a RAM component 1134. The ROM component1132 is in electrical and logical communication with the controller 1122via line 1136, and the RAM component 1134 is in electrical and logicalcommunication with the controller 1122 via line 1138. The RAM component1134 may include any type of random-access memory, such as, for example,a magnetic memory device, an optical memory device, a magneto-opticalmemory device, an electronic memory device, etc. Similarly, the ROMcomponent 1132 may include any type of read-only memory, such as, forexample, a removable memory device, such as a PC-Card or PCMCIA-typedevice. It should be appreciated that the ROM component 1132 and the RAMcomponent 1134 may be embodied as a single unit or may be separate unitsand that the ROM component 1132 and/or the RAM component 1134 may beprovided in the form of a PC-Card or PCMCIA-type device. The controller1122 is further connected to the front panel 15 of the housing 14 and,more particularly, to the display device 16 via line 1154 and theindicators 18 a, 18 b via respective lines 1156, 1158. The lines 1116,1118, 1124, 1126, 1128 electrically and logically connect the controller1122 to the first, second, third, fourth and fifth motors 76, 80, 84,90, 96, respectively. A wired remote control unit (“RCU”) 1150 iselectrically and logically connected to the controller 1122 via line1152. A wireless RCU 1148 is also provided and communicates via awireless link 1160 with a receiving/sending unit 1146 connected via line1144 to a transceiver 1140. The transceiver 1140 is electrically andlogically connected to the controller 1122 via line 1142. The wirelesslink 1160 may be, for example, an optical link, such as an infraredlink, a radio link or any other form of wireless communication link.

A switch device 1186, which may be, for example, an array of DIPswitches, may be connected to the controller 1122 via line 1188. Theswitch device 1186 may be used, for example, to select one of aplurality of languages used in displaying messages and prompts on thedisplay device 16. The messages and prompts may relate to, for example,the operation and/or the status of the electro-mechanical surgicalsystem 10 and/or to the surgical attachment attached thereto.

According to the example embodiment of the present invention, a firstencoder 1106 is provided within the second coupling 26 and is configuredto output a signal in response to and in accordance with the rotation ofthe first drive shaft 30. A second encoder 1108 is also provided withinthe second coupling 26 and is configured to output a signal in responseto and in accordance with the rotation of the second drive shaft 32. Thesignal output by each of the encoders 1106, 1108 may represent therotational position of the respective drive shaft 30, 32 as well as therotational direction thereof. Such encoders 1106, 1108 may be, forexample, Hall-effect devices, optical devices, etc. Although theencoders 1106, 1108 are described as being disposed within the secondcoupling 26, it should be appreciated that the encoders 1106, 1108 maybe provided at any location between the motor system and the surgicalinstrument or attachment. It should be appreciated that providing theencoders 1106, 1108 within the second coupling 26 or at the distal endof the flexible shaft 20 provides for an accurate determination of thedrive shaft rotation. If the encoders 1106, 1108 are disposed at theproximal end of the flexible shaft 20, windup of the first and secondrotatable drive shafts 30, 32 may result in measurement error.

FIG. 6( c) is a schematic view of an encoder 1106, 1108, which includesa Hall-effect device. Mounted non-rotatably on drive shaft 30, 32 is amagnet 240 having a north pole 242 and a south pole 244. The encoder1106, 1108 further includes a first sensor 246 and second sensor 248,which are disposed approximately 90° apart relative to the longitudinal,or rotational, axis of drive shaft 30, 32. The output of the sensors246, 248 is persistent and changes its state as a function of a changeof polarity of the magnetic field in the detection range of the sensor.Thus, based on the output signal from the encoders 1106, 1108, theangular position of the drive shaft 30, 32 may be determined withinone-quarter revolution and the direction of rotation of the drive shaft30, 32 may be determined. The output of each encoder 1106, 1108 istransmitted via a respective line 1110, 1112 of data transfer cable 38to controller 1122. The controller 1122, by tracking the angularposition and rotational direction of the drive shafts 30, 32 based onthe output signal from the encoders 1106, 1108, can thereby determinethe position and/or state of the components of the surgical attachment100 connected to the electro-mechanical surgical system 10. That is, bycounting the revolutions of the drive shaft 30, 32, the controller 1122can determine the position and/or state of the components of thesurgical attachment 100 connected to the electro-mechanical surgicalsystem 10.

The surgical attachment 100 may further include, according to oneembodiment and as shown in FIG. 6( d), a data connector 1272 adapted bysize and configuration to electrically and logically connect to theconnector 70 of the second coupling 26. In the example embodiment, thedata connector 1272 includes contacts (not shown) equal in number to thenumber of leads 72 of the connector 70. Contained within the surgicalattachment 100 is a memory unit 1174 electrically and logicallyconnected with the data connector 1272. The memory unit 1174 may be inthe form of, for example, an EEPROM, EPROM, etc. and may be contained,for example, within the staple and blade portion 106 of the surgicalattachment 100.

FIG. 6( d) schematically illustrates the memory unit 1174. As seen inFIG. 6( d), the data connector 1272 includes contacts 1276, eachelectrically and logically connected to the memory unit 1174 via arespective line 1278. The memory unit 1174 is configured to store, forexample, a serial number data 1180, an attachment type identifier (ID)data 1182 and a usage data 1184. The memory unit 1174 may additionallystore other data. Both the serial number data 1180 and the ID data 1182may be configured as read-only data. In the example embodiment, theserial number data 1180 is data uniquely identifying the particularsurgical attachment, whereas the ID data 1182 is data identifying thetype of the attachment (when, for instance, other types of attachmentsmay be employed by the device). The usage data 1184 represents usage ofthe particular attachment, such as, for example, the number of times theanvil assembly 112 of the surgical attachment 100 has been retracted orextended, or the number of times that the staple pusher 220 of thesurgical attachment 100 has been advanced or fired, as set forth morefully below.

It should be appreciated that the surgical attachment 100 attachable tothe distal end 24 of the flexible shaft 20 may be designed andconfigured to be used a single time or multiple times. The surgicalattachment 100 may also be designed and configured to be used apredetermined number of times. Accordingly, the usage data 1184 may beused to determine whether the surgical attachment 100 has been used andwhether the number of uses has exceeded the maximum number of permitteduses. As more fully described below, an attempt to use the surgicalattachment 100 after the maximum number of permitted uses has beenreached will generate an ERROR condition.

Referring again to FIG. 6( b), in accordance with the example embodimentof the present invention, the controller 1122 is configured to read theID data 1182 from the memory unit 1174 of the surgical attachment 100when the surgical attachment 100 is initially connected to the flexibleshaft 20. The memory unit 1174 is electrically and logically connectedto the controller 1122 via line 1120 of data transfer cable 38. Based onthe read ID data 1182, the controller 1122 is configured to read orselect from the memory unit 1130, an operating program or algorithmcorresponding to the type of surgical instrument or attachment connectedto the flexible shaft 20. The memory unit 1130 is configured to storethe operating programs or algorithms for each available type of surgicalinstrument or attachment, the controller 1122 selecting and/or readingthe operating program or algorithm from the memory unit 1130 inaccordance with the ID data 1182 read from the memory unit 1174 of anattached surgical instrument or attachment. As indicated above, thememory unit 1130 may include a removable ROM component 1132 and/or RAMcomponent 1134. Thus, the operating programs or algorithms stored in thememory unit 1130 may be updated, added, deleted, improved or otherwiserevised as necessary. The operating programs or algorithms stored in thememory unit 1130 may be customizable based on, for example, specializedneeds of the user. A data entry device, such as, for example, akeyboard, a mouse, a pointing device, a touch screen, etc., may beconnected to the memory unit 1130 via, for example, a data connectorport, to facilitate the customization of the operating programs oralgorithms. Alternatively or additionally, the operating programs oralgorithms may be customized and preprogrammed into the memory unit 1130remotely from the electro-mechanical surgical system 10. It should beappreciated that the serial number data 1180 and/or the usage data 1184may also be used to determine which of a plurality of operating programsor algorithms is read or selected from the memory unit 1130. It shouldbe appreciated that the operating program or algorithm may alternativelybe stored in the memory unit 1174 of the surgical attachment 100 andtransferred to the controller 1122 via the data transfer cable 38. Oncethe appropriate operating program or algorithm is read or selected by,or transmitted to, the controller 1122, the controller 1122 causes theoperating program or algorithm to be executed in accordance withoperations performed by the user via the wired RCU 1150 and/or thewireless RCU 1148. As indicated hereinabove, the controller 1122 iselectrically and logically connected with the first, second, third,fourth and fifth motors 76, 80, 84, 90, 96 via respective lines 1116,1118, 1124, 1126, 1128 and controls such motors 76, 80, 84, 90, 96 inaccordance with the read, selected or transmitted operating program oralgorithm via the respective lines 1116, 1118, 1124, 1126, 1128.

Referring now to FIG. 6( e), there is seen a schematic view of awireless RCU 1148. The wireless RCU 1148 includes a steering controller1300 having a plurality of switches 1302, 1304, 1306, 1308 arrangedunder a four-way rocker 1310. The operation of switches 1302, 1304, viathe rocker 1310, controls the operation of the first and second steeringcables 34, 35 via the third motor 84. Similarly, the operation of theswitches 1306, 1308, via the rocker 1310, controls the operation of thethird and fourth steering cables 36, 37 via the fourth motor 92. Itshould be appreciated that the rocker 1310 and the switches 1302, 1304,1306, 1308 are arranged so that the operation of the switches 1302, 1304steers the flexible shaft 20 in the north-south direction and that theoperation of the switches 1306, 1308 steers the flexible shaft 20 in theeast-west direction. Reference herein to north, south, east and west ismade to a relative coordinate system. Alternatively, a digital joystick,analog joystick, etc. may be provided in place of the rocker 1310 andthe switches 1302, 1304, 1306, 1308. Potentiometers or any other type ofactuator may also be used in place of the switches 1302, 1304, 1306,1308.

The wireless RCU 1148 further includes a steering engage/disengageswitch 1312, the operation of which controls the operation of the fifthmotor 96 to selectively engage and disengage the steering mechanism. Thewireless RCU 1148 also includes a two-way rocker 1314 having first andsecond switches 1316, 1318 operable thereby. The operation of theseswitches 1316, 1318 controls certain functions of the electro-mechanicalsurgical system 10 and any surgical attachment, such as surgicalattachment 100, attached to the flexible shaft 20 in accordance with theoperating program or algorithm corresponding to the attached surgicalattachment, if any. For example, where the surgical instrument is thesurgical attachment 100, such as that shown in FIG. 1 and describedhereinbelow, operation of the two-way rocker 1314 may control theextension and retraction of the anvil assembly 112 of the surgicalattachment 100. The wireless RCU 1148 is provided with yet anotherswitch 1320, the operation of which may further control the operation ofthe electro-mechanical surgical system 10 and any surgical attachmentattached to the flexible shaft 20 in accordance with the operatingprogram or algorithm corresponding to the attached surgical attachment,if any. For example, when the surgical attachment 100 is attached to theflexible shaft 20, operation of the switch 1320 may initiate theadvancement, or firing sequence, of the staple pusher 220.

The wireless RCU 1148 includes a controller 1322, which is electricallyand logically connected with the switches 1302, 1304, 1306, 1308 vialine 1324, with the switches 1316, 1318 via line 1326, with the switch1312 via line 1328 and with the switch 1320 via line 1330. The wirelessRCU 1148 may include indicators 18 a′, 18 b′, corresponding to theindicators 18 a, 18 b of the front panel 15, and a display device 16′,corresponding to the display device 16 of the front panel 15. Ifprovided, the indicators 18 a′, 18 b′ are electrically and logicallyconnected to the controller 1322 via respective lines 1332, 1334, andthe display device 16′ is electrically and logically connected to thecontroller 1322 via line 1336. The controller 1322 is electrically andlogically connected to a transceiver 1338 via line 1340, and thetransceiver 1338 is electrically and logically connected to areceiver/transmitter 1342 via line 1344. A power supply, not shown, forexample, a battery, may be provided in the wireless RCU 1148 to powerthe same. Thus, the wireless RCU 1148 may be used to control theoperation of the electro-mechanical surgical system 10 and any surgicalattachment 100 attached to the flexible shaft 20 via wireless link 1160.

The wireless RCU 1148 may include a switch 1346 connected to thecontroller 1322 via line 1348. Operation of the switch 1346 transmits adata signal to the transmitter/receiver 1146 via the wireless link 1160.The data signal includes identification data uniquely identifying thewireless RCU 1148. This identification data is used by the controller1122 to prevent unauthorized operation of the electro-mechanicalsurgical system 10 and to prevent interference with the operation of theelectro-mechanical surgical system 10 by another wireless RCU. Eachsubsequent communication between the wireless RCU 1148 and theelectro-mechanical surgical system 10 may include the identificationdata. Thus, the controller 1122 can discriminate between wireless RCUsand thereby allow only a single, identifiable wireless RCU 1148 tocontrol the operation of the electro-mechanical surgical system 10 andany surgical attachment attached to the flexible shaft 20.

Based on the positions of the components of the surgical attachment 100attached to the flexible shaft 20, as determined in accordance with theoutput signals from the encoders 1106, 1108, the controller 1122 mayselectively enable or disable the functions of the electro-mechanicalsurgical system 10 as defined by the operating program or algorithmcorresponding to the attached surgical attachment 100. For example,where the surgical attachment is the surgical attachment 100 illustratedin FIG. 1, the firing function controlled by the operation of the switch1320 is disabled unless the space or gap between the anvil assembly 112and the staple and blade portion 106 is determined to be within anacceptable range. The space or gap between the anvil assembly 112 andthe staple and blade portion 106 is determined based on the outputsignal from the encoders 1106, 1108, as more fully describedhereinabove. It should be appreciated that the switch 1320 itselfremains operable but that the controller 1122 does not effect thecorresponding function unless the space or gap is determined to bewithin the acceptable range.

Referring now to FIG. 6( f), there is seen a schematic view of a wiredRCU 1150. In the example embodiment, the wired RCU 1150 includessubstantially the same control elements as the wireless RCU 1148 andfurther description of such elements is omitted. Like elements are notedin FIG. 6( f) with an accompanying prime. It should be appreciated thatthe functions of the electro-mechanical surgical system 10 and anysurgical attachment attached to the flexible shaft 20 may be controlledby the wired RCU 1150 and/or by the wireless RCU 1148. In the event of abattery failure, for example, in the wireless RCU 1148, the wired RCU1150 may be used to control the functions of the electro-mechanicalsurgical system 10 and any surgical attachment 100 attached to theflexible shaft 20.

As described hereinabove, the front panel 15 of housing 14 includesdisplay device 16 and indicators 18 a, 18 b. The display device 16 mayinclude an alpha-numeric display device, such as an LCD display device.The display device 16 may also include an audio output device, such as aspeaker, a buzzer, etc. The display device 16 is operated and controlledby controller 1122 in accordance with the operating program or algorithmcorresponding to a surgical attachment 100 attached to the flexibleshaft 20. If no surgical attachment is so attached, a default operatingprogram or algorithm may be read or selected by, or transmitted to,controller 1122 to thereby control the operation of the display device16 as well as the other aspects and functions of the electro-mechanicalsurgical system 10. If the surgical attachment 100 illustrated in FIG. 1is attached to flexible shaft 20, display device 16 may display, forexample, data indicative of the gap between the anvil assembly 112 andthe staple and blade portion 106 as determined in accordance with theoutput signal of encoders 1106, 1108, as more fully describedhereinabove.

Similarly, the indicators 18 a, 18 b are operated and controlled by thecontroller 1122 in accordance with the operating program or algorithmcorresponding to the surgical attachment 100 attached to the flexibleshaft 20. The indicator 18 a and/or the indicator 18 b may include anaudio output device, such as a speaker, a buzzer, etc., and/or a visualindicator device, such as an LED, a lamp, a light, etc. If the surgicalattachment 100 illustrated in FIG. 1 is attached to the flexible shaft20, the indicator 18 a may indicate, for example, that theelectro-mechanical surgical system 10 is in a power ON state, and theindicator 18 b may, for example, indicate whether the gap between theanvil assembly 112 and the staple and blade portion 106 is determined tobe within the acceptable range as more fully described hereinabove. Itshould be appreciated that although only two indicators 18 a, 18 b aredescribed, any number of additional indicators may be provided asnecessary. Additionally, it should be appreciated that although a singledisplay device 16 is described, any number of additional display devicesmay be provided as necessary.

The display device 16′ and the indicators 18 a′, 18 b′ of the wirelessRCU 1150 and the display device 16″ and the indicators 18 a″, 18 b″ ofthe wired RCU 1148 are similarly operated and controlled by therespective controller 1322, 1322′ in accordance with the operatingprogram or algorithm corresponding to the surgical attachment 100attached to the flexible shaft 20.

Hereinbelow is described the surgical attachment 100 illustrated forinstance in FIG. 1, in accordance with various embodiments of thepresent invention.

FIGS. 7( a) to 7(f) are various views of the handle portion 102 of thesurgical attachment 100, according to one embodiment of the presentinvention. For instance, FIG. 7( a) is a front perspective view, andFIG. 7( b) is a rear perspective view, of the handle portion 102including a housing 301. At a proximal end 301 a of the housing 301 isdisposed a gear housing 302. At a distal end 301 b of the housing 301 isdisposed a coupling block 305. Extending from the gear housing 302 is aquick connect coupling 304 and an extension rod 308.

The quick-connect coupling 304 is mounted onto the gear housing 302 andmay be biased, e.g., via a set of springs. The gear housing 302 includesa first drive socket 304 a and a second drive socket 304 b. FIG. 7( c)is an exploded front perspective view of the handle portion 102. Asshown in FIG. 7( c), the first drive socket 304 a includes a first inputelement 306 a, one end 3061 of which extends through an opening 3021 ofthe gear housing 302 and the other end 3062 of which includes spur gearteeth 3063. The second drive socket 304 b includes a second inputelement 306 b, one end 3064 of which extends through a second opening3022 of the gear housing 302 and the other end 3065 of which includesspur gear teeth 3066.

The extension rod 308 extends through an extension rod opening 3025 inthe gear housing 302. The distal end 308 b of the extension rod 308 hasa flange 3081 that is larger than the extension rod opening 3025 suchthat the flange 3081 of the extension rod 308 is retained within thegear housing 302. The flange 3081 of the extension rod 308 abuts oneside of the spur gear 310, the spur gear 310 being seated within aninternal recess 3023 of the gear housing 302. The spur gear 310 hasarranged along its outer circumference spur gear teeth 3101 thatcorrespond to the spur gear teeth 3063 of the first input element 306 a.Extending through an internally threaded bore 3102 of the spur gear 310is externally threaded rod 312 that is arranged coaxially relative tothe extension rod 308. The rod 312 is connected to a coupling element314 that is positioned within a first opening 3052 of the coupling block305. The rod coupling 314 may provide a connection to the first driveshaft 104 a of the flexible shaft 104.

Also seated within an internal recess 3024 of the gear housing 302 is aspur gear 318. The spur gear 318 has arranged along its outercircumference spur gear teeth 3181 that correspond to the spur gearteeth 3066 of the second input element 306 b. The spur gear 318 has abore 3182 extending therethrough. Non-rotatably engaged within the bore3182 of the spur gear 318 is a first end 3161 of a shaft drive element316. A second end 3162 of the shaft drive element 316 is configured tonon-rotatably engage the second drive shaft 104 b of the flexible shaft104, which extends through a second opening 3053 in the distal face 3051of the coupling block 305.

FIG. 7( d) is a top view of the handle portion 102 illustrated in FIG.7( a). FIG. 7( e) is a side cross-sectional view of the handle portion102 illustrated in FIG. 7( d) taken along the lines A-A. FIG. 7( f) is aside cross-sectional view of the handle portion 102 illustrated in FIG.7( d) taken along the lines B-B.

FIG. 8 is a perspective view of the cutting and stapling component 103of the surgical attachment 100, according to one embodiment of thepresent invention. As shown in FIG. 8 and as previously described, thecutting and stapling component 103 includes a staple and blade portion106. Extending in an axial direction through a centrally disposedopening of the staple and blade portion 106 is a trocar shaft 108. Thetrocar shaft 108 may be flexible. In one embodiment, the trocar shaft108 is a cable. Disposed at a distal end 108 a of the trocar shaft 108is a trocar 110. The trocar 110 has a sharp or pointed end that isconfigured to be pushed through a section of tissue. In addition, thetrocar 110 is configured to engage an anvil assembly 112, preferably bybeing insertable within a slot of the anvil assembly 112 for detachablyfixing the trocar 110, and thus the trocar shaft 108 attached thereto,to the anvil assembly 112 as set forth more fully below. The surgicalattachment 100 is configured such that the trocar shaft 108, and theanvil assembly 112 attached thereto, may be selectively moved, e.g.,extended and retracted, relative to the staple and blade portion 106, asset forth more fully below. Specifically, the trocar shaft 108, havingthe trocar 110 disposed at its end, is extendable and retractable bymovement in first and second, e.g., distal and proximal, directions,respectively, to a desired distance relative to the staple and bladeportion 106.

FIG. 9 is a perspective view that illustrates a cutting and staplingcomponent 103, according to one embodiment of the present invention.FIG. 9 shows the cutting and stapling component 103 in an assembled,partially closed position. Specifically, FIG. 9 illustrates the anvilassembly 112 in a partially retracted position relative to the stapleand blade portion 106.

FIG. 10( a) is a perspective view that illustrates the components of theanvil assembly 112, according to one embodiment of the presentinvention. FIG. 10( a) shows the anvil assembly 112 in an explodedcondition. As shown in FIG. 10( a), the anvil assembly 112 includes ananvil end cap 202. The anvil end cap 202 has a centrally-disposedopening 2021 arranged in the axial direction. The anvil end cap 202 alsoincludes a radially-disposed slot 2022 on a distal side 2025 of the endcap 202, and a clamping face 2023 on a proximal side 2026 of the anvilend cap 202. The clamping face 2023 has a recessed portion that forms ablade repository 2024. The clamping face 2023 also defines staple guides2026.

The anvil assembly 112 also includes a pin 204 correspondingcross-sectionally to the slot 2022 of the anvil end cap 202. The anvilassembly 112 also includes a hollow anvil sleeve 208. A distal end 2081of the anvil sleeve 208 corresponds cross-sectionally to the opening2021 of the anvil end cap 202. In addition, the distal end 2081 of theanvil sleeve 208 defines openings 2082 that correspond cross-sectionallyto the anvil pin 204. In a proximal end 2084 of the anvil sleeve 208there is defined a recess 2086 that extends circumferentially around theanvil sleeve 208 and that has a radius that is smaller than the radiusof the other portions of the anvil sleeve 208, including the radius ofseveral radially-extending teeth 2087 located at the proximal-most endof the anvil sleeve 208. The proximal end 2084 of the anvil sleeve 208also defines a plurality, e.g., four, axial slots 2088 that extendthrough the recess 2086 and the teeth 2087, thereby enabling theproximal end 2084 of the anvil sleeve 208 to be radially compressed. Theanvil sleeve 208 also includes one or more longitudinally-extending keys2085 on its outer surface.

The anvil assembly 112 also includes an anvil extension rod 206. Theanvil extension rod 206 has a distal end 2061 that may be flat and thatdefines an opening 2062. The anvil extension rod 206 also has a centralregion 2063 that is round and that corresponds cross-sectionally to aninner diameter of the recess 2086 of the anvil sleeve 208. The distalend 2061 of the anvil extension rod 206 is cross-sectionally larger thanthe inner diameter of the recess 2086 of the anvil sleeve 208. The anvilextension rod 206 also has a proximal end 2063 that defines a trocarreceiving slot 2065.

FIG. 10( b) is a perspective view that illustrates some of thecomponents of the staple and blade portion 106, according to oneembodiment of the present invention. FIG. 10( b) shows the components inan exploded condition. As shown in FIG. 10( b), the staple and bladeportion 106 includes a hollow anvil sleeve guide 210. The inner surfaceof the anvil sleeve guide 210 includes one or more keyways 2101. Theouter surface of the anvil sleeve guide 210 includes a lip 2102, suchthat a proximal end 2103 of the anvil sleeve guide 210 has a largerradius than a distal end 2104 of the anvil sleeve guide 210.

The staple and blade portion 106 also includes an outer housing sleeve212. The outer housing sleeve 212 has one or more openings 2121 at itsdistal end 2122, and a radially inwardly-extending lip 2123 at thedistal end 2124 of the outer housing sleeve 212. The staple and bladeportion 106 also includes a staple cartridge 214. The staple cartridge214 defines a plurality of axially-disposed staple receiving slots 2141in which staples 2142 are stored. In the embodiment shown in FIG. 10(b), the staple receiving slots 2141 are disposed circumferentiallyaround the staple cartridge 214 in two radially-spaced apart rows,wherein the staple receiving slots 2141 in the first row overlap thestaple receiving slots 2141 in the second row. The staple cartridge 214also includes a radially inwardly-extending lip 2145 located near thedistal end 2147 of the staple cartridge 214 and a radiallyoutwardly-extending lip 2143 located near the proximal end 2144 of thestaple cartridge 214. Furthermore, the distal end 2147 of the staplecartridge 214 defines a clamping face 2146.

The staple and blade portion 106 also includes a frangible bladeprotection ring 216 that defines within its interior a slot 2161. Inaddition, the staple and blade portion 106 includes a blade 218. Theblade 218 has a cutting edge 2183 that extends circumferentially alongits distal end 2184. In addition, the blade 218 defines a radially,inwardly-extending tab or lip 2181 at its proximal end 2182.

The staple and blade portion 106 also includes a staple pusher 220. Thestaple pusher 220 has a plurality of axially-disposed pushing teeth2201, each of which corresponds to and aligns with the staple receivingslots 2141 of the stapler cartridge 214. The staple pusher 220 alsoincludes a key 2202 on its outer surface.

The staple and blade portion 106 also includes a staple pusher carriageelement 222 that has a neck portion 2221 and a flange portion 2222, theneck portion 2221 extending axially in a distal direction relative tothe flange portion 2222. An interior surface of the neck portion 2221includes threads 2223, while an exterior surface of the neck portion2221 defines a circumferentially-disposed recess 2224. In addition, theradially outermost edge of the flange 2222 includes a key 2225.

FIG. 10( c) is a perspective view that illustrates the remainingcomponents of the staple and blade portion 106 in an exploded condition,according to one embodiment of the present invention. As shown in FIG.10( c), the staple and blade portion 106 also includes a split ring 224.The split ring 224 includes a pair of semi-circular ring portions 2241and 2242 that when arranged in the shape of a ring define therebetween apair of keyways 2243 and 2244. The staple and blade portion 106 alsoincludes a washer 226. The staple and blade portion 106 also includes athrust element 228 that has a neck portion 2281 and a flange portion2282, the neck portion 2281 extending axially in a distal directionrelative to the flange portion 2282. A bore 2283 is defined within theinterior of the neck portion 2281, while an exterior surface of the neckportion 2281 defines threads 2284 that correspond to the threads 2223located on the interior surface of the neck portion 2221 of the staplepusher carriage element 222. The flange 2282 of the thrust element 228includes one or more bores 2285 within its distally-facing surface, anda proximally-extending pin 2286 having, e.g., a round cross section.

The staple and blade portion 106 also includes a first spur gear 230.The first spur gear 230 defines an internal bore 2301 that correspondscross-sectionally to the pin 2286 of the thrust element 228. The firstspur gear 230 also includes circumferentially-disposed spur gear teeth2302. The staple and blade portion 106 also includes a washer 232, andan inner housing sleeve 234. The inner housing sleeve 234 includes aninternal bore 2341 that has a first interior radius at a distal end 2342of the inner housing sleeve 234. The internal bore 2341 extendsproximally towards a radially inwardly-extending lip 2345 at which pointthe interior radius of the internal bore 2342 is reduced. The internalbore 2342 extends still further proximally to a second radiallyinwardly-extending lip 2346 at which point the interior radius of theinternal bore 2342 is again reduced. Proximal to the second lip 2346 aregear teeth 2347 that extend circumferentially along the interior surfaceof the inner housing sleeve 234. A proximal end 2343, e.g., proximalrelative to the gear teeth 2347, has a smooth interior surface, and hasone or more radial openings 2344 defined therein.

The staple and blade portion 106 also includes a sun gear element 236that has a neck portion 2361 and a flange portion 2362, the neck portion2361 extending axially in a distal direction relative to the flangeportion 2362. A bore 2363 is defined within the interior of the neckportion 2361, while an exterior surface of the neck portion 2361 hascircumferentially-disposed gear teeth 2364 that correspond to the gearteeth 2302 of the first spur gear 230. The flange portion 2362 includesa proximally-extending pin 2366 having, e.g., a round cross section. Thestaple and blade portion 106 also includes a washer 238.

The staple and blade portion 106 also includes a first planetary gear240 having an internal bore 2401. An exterior surface of the firstplanetary gear 240 has circumferentially-disposed gear teeth 2402. Thestaple and blade portion 106 also includes a sun gear 242 having aninternal bore 2421. An exterior surface of the sun gear 242 hascircumferentially-disposed gear teeth 2422 that correspond to the gearteeth 2402 of the first planetary gear 240. The staple and blade portion106 also includes a washer 244 having a tab 2441. The staple and bladeportion 106 also includes a second planetary gear 246 having an internalbore 2461. An exterior surface of the second planetary gear 246 hascircumferentially-disposed gear teeth 2462 that correspond tocircumferentially-disposed gear teeth 2422 of the sun gear 242.

The staple and blade portion 106 also includes an input element 248. Adistal end 2481 of the input element 248 has an internal bore 2483,which may have, e.g., a square cross-section. On an outer surface of thedistal end 2481 of the input element 248 are circumferentially-disposedgear teeth 2482 that correspond to the circumferentially-disposed gearteeth 2462 on the exterior surface of the second planetary gear 246. Aproximal end 2484 of the input element 248 has a round outercircumference and an internal bore 2485.

The staple and blade portion 106 also includes a housing rear endcap 250having a central bore 2501, a second bore 2502 radially offset relativeto the central bore 2501, and a recess 2503 from which a pin 2504extends in a distal direction. The housing rear endcap 250 also includesan outer radial lip 2505. Located distally relative to the outer radiallip 2505 is at least one opening 2506 defined within a round outercircumferential surface 2507. The housing rear endcap 250 also includesat its proximal end one or more keyways 2509 in communication with thecentral bore 2501.

The staple and blade portion 106 also includes a central rear endcapsleeve 252 having a bore 2521 disposed therethrough. At a distal end2522 of the central rear endcap sleeve 252, the bore 2521 defines aradially inwardly-extending rim 2523. At a proximal end 2524 of thecentral rear endcap sleeve 252 are oppositely-disposed keyways 2525.

The staple and blade portion 106 also includes a retainer sleeve 254having a bore 2541 disposed therethrough. At a proximal end 2542 of theretainer sleeve 254 are oppositely-disposed keys 2543 that correspond tothe oppositely-disposed keyways 2525 located at the proximal end 2524 ofthe central rear endcap sleeve 252 and the keyways 2509 of the rearhousing endcap 250.

FIG. 11( a) is a top, cross-sectional view and FIG. 11( b) is a side,cross-sectional view that illustrate the cutting and stapling component103, according to one embodiment of the present invention. FIGS. 11( a)and 11(b) show the cutting and stapling component 103 in an assembledand partially retracted position, as set forth more fully below. Asshown in FIGS. 11( a) and 11(b), the distal end 2081 of the anvil sleeve208 is inserted into the corresponding, centrally-disposed opening 2021in the anvil end cap 202. The anvil pin 204 is inserted through theradially-disposed slot 2022 of the end cap 202 and through theoppositely-disposed openings 2082 in the distal end 2081 of the anvilsleeve 208 so that the anvil end cap 202 is axially and rotatably fixedrelative to the anvil sleeve 208. The distal end 2061 of the anvilextension rod 206 is axially retained within the recess 2086 at theproximal end 2084 of the anvil sleeve 208. The anvil sleeve 208 isaxially and slidably retained within the interior of the anvil sleeveguide 210. The anvil sleeve 208 is prevented from rotating relative tothe anvil sleeve guide 210 by the engagement of the keys 2085 of theanvil sleeve 208 within the keyways 2101 of the anvil sleeve guide 210.

Extending through the central opening 2501 of the housing rear end 250and into the proximal end 2103 of the anvil sleeve guide 210 is thecentral rear endcap sleeve 252. In the position shown, the rim 2523 ofthe central rear endcap sleeve 252 is engaged within the recess 2086 ofthe anvil sleeve 208, thereby axially fixing the central rear endcapsleeve 252 and the anvil sleeve 208 relative to each other. Insertedinto the bore 2521 of the central rear endcap sleeve 252 is the retainersleeve 254. The keys 2543 of the retainer sleeve 254 engage the keyways2525 of the central rear endcap sleeve 252 and the keyways 2509 of thehousing rear endcap 250 so as to prevent relative rotation between theretainer sleeve 254, the central rear endcap sleeve 252 and the housingrear endcap 250.

The input element 248 is rotatably maintained within the second opening2502 of the housing rear end cap 250. The teeth 2482 of the inputelement 248 are in meshing engagement with thecircumferentially-disposed teeth 2462 of the second planetary gear 246,which is rotatably mounted on the pin 2504 extending distally from therecess 2503 of the housing rear endcap 250. Thecircumferentially-disposed teeth 2462 of the second planetary gear 246are also in meshing engagement with circumferentially-disposed teeth2422 of the sun gear 242. The sun gear 242 is rotatably mounted via itsinternal bore 2421 on the proximal end 2103 of the anvil sleeve guide210.

The circumferentially-disposed teeth 2422 of the sun gear 242 are alsoin meshing engagement with the circumferentially-disposed teeth 2402 ofthe first planetary gear 240. The first planetary gear 240 is rotatablymounted on the pin 2361 that extends proximally from the flange portion2362 of the sun gear element 236. The circumferentially-disposed teeth2402 of the first planetary gear 240 are also in meshing engagement withthe gear teeth 2347 that extend circumferentially around the interiorsurface of the inner housing sleeve 234. The inner housing sleeve 234 isrotatably and axially fixed relative to the housing rear endcap 250 andthe outer housing sleeve 212 by the insertion of fasteners 256, e.g.,pins or screws, through aligned openings 2121, 2344 and 2506 in theouter housing sleeve 212, the inner housing sleeve 234 and the housingrear endcap 250, respectively.

The sun gear element 236 is rotatably mounted via its internal bore 2363on the anvil sleeve guide 210. The circumferentially-disposed gear teeth2364 on the exterior surface of the neck portion 2361 of the sun gearelement 236 are in meshing engagement with thecircumferentially-disposed gear teeth 2302 of the first spur gear 230.The first spur gear 230 is rotatably mounted on the thrust element 228by the internal bore 2301 of the first spur gear 230 having insertedtherein the proximally-extending pin 2286 of the thrust element 228. Thecircumferentially-disposed gear teeth 2302 of the first spur gear 230are also in meshing engagement with the gear teeth 2347 that extendcircumferentially around the interior surface of the inner housingsleeve 234.

The thrust element 228 is rotatably mounted on the anvil sleeve guide210 by the anvil sleeve guide 210 fitting within the internal bore 2283of the thrust element 228. The washer 232 resides between the proximalsurface of the flange 2282 of the thrust element 282 and the second lip2346 of the inner housing sleeve 234, while the washer 226 residesbetween the distal surface of the flange 2282 of the thrust element 282and the flange 2222 of the staple cartridge carrier element 222.

The staple pusher carriage element 222 is mounted on the thrust element228 such that the threads 2223 located on the interior surface of theneck portion 2221 of the staple pusher carriage element 222 are inthreaded engagement with the threads 2284 located on the exteriorsurface of the neck portion 2281 of the thrust element 228. The keys2225 of the staple pusher carriage element 222 are engaged within thekeyways 2243 formed by the split ring 224, thereby enabling the staplepusher carriage element 222 to be axially slidable relative to the splitring 224. The split ring is positioned within the bore 2341 at thedistal end 2342 of the inner housing sleeve 234.

Located within the split ring 224, and abutting the flange 2282 of thethrust element 228 is the staple pusher 220. The keys 2202 of the staplepusher 220 are engaged within the keyways 2243 formed by the split ring224, thereby enabling the staple pusher 220 to be axially slidablerelative to the split ring 224. The pushing teeth 2201 of the staplepusher 220 extend distally and align with the staple receiving slots2141 of the staple cartridge 214.

The staple cartridge 214 is positioned distally relative to the staplepusher 220 and is maintained within the interior of the outer housingsleeve 212. The staple cartridge 214 is axially moveable in a distaldirection within the outer housing sleeve 212 from the position shown inFIGS. 11( a) and 11(b) until the radially, outwardly-extending lip 2143of the staple cartridge 214 abuts the radially, inwardly-extending lip2123 of the outer housing sleeve 212 as set forth more fully below.

Located between the staple pusher 220 and the staple pusher carriageelement 222 is the blade 218. The radially, inwardly-extending tab orlip 2185 located at the distal end 2182 of the blade is engaged withinthe recess 2224 located on the outer surface of the neck portion 2221 ofthe staple pusher carriage element 222. The cutting edge 2183 of theblade 218 is sheathed within the slot 2161 of the frangible bladeprotection ring 216. The frangible blade protection ring 216 axiallyabuts the radially inwardly-extending lip 2144 of the staple cartridge214.

In operation, the surgical attachment 100 is attached via the quickconnect coupling 304 of the handle portion 102 to the flexible shaft 20such that the first rotatable drive shaft 30 of the flexible shaft 201is coupled, e.g., non-rotatably, to the first input element 306 a of thehandle portion 102 and such that the second rotatable drive shaft 32 ofthe flexible shaft 20 is coupled, e.g., non-rotatably, to the secondinput element 306 b of the handle portion 102. Initially, the trocarshaft 108 of the surgical attachment 100 may be in a retracted position,such as illustrated in FIG. 9, so as to facilitate the insertion of thesurgical attachment 100 into the body of a patient. For instance, inthis position, the staple and blade portion 106 may be inserted into anoral passage of the patient. The controller 1122 may initially beconfigured to operate in a clamping mode. In the clamping mode, rotationof the first rotatable drive shaft 30 in a first direction, e.g.,clockwise when viewed from the proximal end, causes rotation of theinput element 306 a in the first direction. By the meshing engagement ofthe gear teeth 3063 of the first input element 306 a with the spur gearteeth 3101 of the spur gear 310, the spur gear 310 is caused to rotatein a second direction, e.g., counter-clockwise when viewed from theproximal end. Rotation of the spur gear 310 in the second directioncauses the rod 312, the threads of which are engaged within the threadedinternal bore 3102 of the spur gear 310, to move axially within thehousing portion 102. The coupling element 314 at the end of the rod 312is engaged, e.g., non-rotatably, with the first drive shaft 104 a of theflexible shaft 104, which in turn is engaged, e.g., non-rotatably, withthe trocar shaft 108 extending through the staple and blade portion 106of the cutting and stapling component 103. In this manner, the trocarshaft 108, having the trocar 110 disposed at its end, may be extended bymovement in a first, e.g., distal, direction to a desired distancerelative to the staple and blade portion 106. The trocar 110 is pushedthrough a section of tissue desired to be stapled and is inserted withinthe trocar receiving slot 2065 of the anvil extension rod 206 so as tobe axially fixed relative to the anvil extension rod 206. The trocarshaft 108 is then retracted by operation of the first rotatable driveshaft 30 in the opposite direction so as to draw the anvil extension rod206, and the other components of the anvil assembly 112, into the anvilsleeve guide 210.

As the trocar shaft 108 is further retracted by continued rotation ofthe first rotatable drive shaft 30 in, e.g., the second direction, thekeys 2085 of the anvil sleeve 208 engage with the keyways 2101 withinthe anvil sleeve guide 210 to thereby align the anvil assembly 112 withthe staple and blade portion 106. Still further retraction of the trocarshaft 108 causes the anvil sleeve 108 to move proximally within theanvil sleeve guide 210 until the rim 2523 of the central rear endcapsleeve 252 seats within the recess 2086 of the anvil sleeve 208. Whenthe rim 2523 of the central rear endcap sleeve 252 seats within therecess 2086 of the anvil sleeve 208, the anvil assembly 112 is axiallylocked in position relative to the staple and blade portion 106.According to one embodiment of the present invention, the anvil assembly112 is axially locked in position relative to the staple and bladeportion 106 when the clamping face 2023 of the anvil end cap 202 is at adistance of approximately 5 mm from the clamping face 2146 of the staplecartridge 214.

Once the anvil assembly 112 is axially locked in position relative tothe staple and blade portion 106, the controller 1122 may cease rotationof the first rotatable drive shaft 30 in the second direction. Thecontroller 1122 may then change to a firing mode of operation. In thefiring mode of operation, the second rotatable drive shaft 32 may berotated in a first, e.g., clockwise, direction, which in turn rotatesthe input element 306 b in the first direction. By the meshingengagement of the gear teeth 3066 of the input element 306 b with thespur gear teeth 3181 of the spur gear 318, the spur gear 318 is causedto rotate in a second, e.g., counter-clockwise, direction. Rotation ofthe spur gear 318 in the second direction causes the shaft drive element316, and the second drive shaft 104 b of the flexible shaft 104 which isnon-rotatably connected to the shaft drive element 316, to rotate in thesecond direction. Rotation of the second drive shaft 104 b of theflexible shaft 104 thereby causes the input element 248 of the stapleand blade portion 106 to which it is non-rotatably coupled to alsorotate in the second direction. Thus, the input element 248 rotateswithin the second opening 2502 of the housing rear end cap 250. By themeshing engagement of the teeth 2482 of the input element 248 with thecircumferentially-disposed teeth 2462 of the second planetary gear 246,rotation of the input element 248 in the second direction causesrotation of the second planetary gear 246 on the pin 2504 in the firstdirection. Additionally, by the meshing engagement of thecircumferentially-disposed teeth 2462 of the second planetary gear 246with circumferentially-disposed teeth 2422 of the sun gear 242, rotationof the second planetary gear 246 in the first direction causes rotationof the sun gear 242 around the proximal end 2103 of the anvil sleeveguide 210 in the second direction.

By the meshing engagement of the circumferentially-disposed teeth 2422of the sun gear 242 with the circumferentially-disposed teeth 2402 ofthe first planetary gear 240, rotation of the sun gear 242 around theproximal end 2103 of the anvil sleeve guide 210 in the second directioncauses rotation of the first planetary gear 240 on the pin 2361extending proximally from the flange portion 2362 of the sun gearelement 236 in the first direction. By the meshing engagement of thecircumferentially-disposed teeth 2402 of the first planetary gear 240with the gear teeth 2347 of the inner housing sleeve 234, and since theinner housing sleeve 234 is rotatably fixed within the staple and bladeportion 106, rotation of the first planetary gear 240 in the firstdirection causes the first planetary gear 240 to revolve within theinner housing sleeve 234 in the second direction. Since the firstplanetary gear 240 is mounted on the pin 2361 extending proximally fromthe flange portion 2362 of the sun gear element 236, the revolvingmotion of the first planetary gear 240 in the second direction causesthe sun gear element 236 to rotate around the anvil sleeve guide 210 inthe second direction.

By the meshing engagement of the gear teeth 2364 on the exterior surfaceof the neck portion 2361 of the sun gear element 236 and the gear teeth2302 of the first spur gear 230, rotation of the sun gear 236 in thesecond direction causes the first spur gear 230 to rotate in the firstdirection. By the meshing engagement of the circumferentially-disposedgear teeth 2302 of the first spur gear 230 with the gear teeth 2347 ofthe inner housing sleeve 234, and since the inner housing sleeve 234 isrotatably fixed within the staple and blade portion 106, rotation of thefirst spur gear 230 in the first direction causes the first spur gear230 to revolve in the second direction within the inner housing sleeve234. Furthermore, since the first spur gear 230 is mounted on the pin2286 extending proximally from the flange portion 2282 of the thrustelement 228, the revolving motion of the first spur gear 230 in thesecond direction causes the thrust element 228 to rotate in the seconddirection around the anvil sleeve guide 210.

The rotation of the thrust element 228 in the second direction aroundthe anvil sleeve guide 210 causes the staple pusher carriage element222, by virtue of the threads 2284 located on the exterior surface ofthe neck portion 2281 of the thrust element 228 being in threadedengagement with the threads 2223 located on the interior surface of theneck portion 2221 of the staple pusher carnage element 222, to moverelative to the thrust element 228. Because the keys 2225 of the staplepusher carriage element 222 are engaged within the keyways 2243 formedby the split ring 224, the staple pusher carriage element 222 is causedto axially slide within the split ring 224 in the distal direction. Thedistal movement of the staple pusher carriage element 222 causes thestaple pusher 220, by virtue of the abutment of the flange 2282 of thethrust element 228 with the staple pusher 220, to also move in thedistal direction.

Movement of the staple pusher 220 in the distal direction causes theblade 218 to move along with the staple pusher 220 in the distaldirection. The cutting edge 2183 of the blade 218, which is sheathedwithin the slot 2161 of the frangible blade protection ring 216, causesthe frangible blade protection ring 216 to be moved distally. Since thefrangible blade protection ring 216 axially abuts the inward lip 2144 ofthe staple cartridge 214, the distal movement of the frangible bladeprotection ring 216 also causes distal movement of the staple cartridge214. Thus, at this stage of operation, the staple pusher 220, the blade218, the frangible blade protection ring 216 and the staple cartridge214 move distally together. The staple cartridge 214 moves distally soas to further clamp a section of tissue (not shown) between the clampingface 2023 of the anvil endcap 202 and the clamping face 2146 of thestaple cartridge 214. Depending on the thickness of the section oftissue, the staple cartridge 214 may move distally until the lip 2143 ofthe staple cartridge 214 abuts the radially, inwardly-extending lip 2123of the outer housing sleeve 212.

Once the staple cartridge 214 has been moved distally sufficiently tocompletely clamp a section of tissue, continued rotation of the secondrotatable drive shaft 32 causes further distal movement of the staplepusher 220, the frangible blade protection ring 216 and the blade 218.Once the frangible blade protection ring 216 and the staple cartridge214 are prevented from further distal movement by contact with acompressed section of tissue, the staple pusher 220 and the blade 218are caused to continue to move distally relative these components.Specifically, further distal movement of the blade 218 causes thecutting edge 2183 of the blade 218 to penetrate the frangible bladeprotection ring 216 and to thereby cut the section of tissue that hasbeen clamped. Advantageously, these components are configured such thatapproximately 70 lbs. or more of pressure is employed to cause thecutting edge 2183 of the blade 218 to penetrate the frangible bladeprotection ring 216 and to thereby cut the section of tissue, therebyensuring that the section of tissue is sufficiently clamped prior tocutting. Simultaneously, further distal movement of the staple pusher220 causes the pushing teeth 2201 of the staple pusher 220, which arealigned with the staple receiving slots 2141 of the stapler cartridge214, to begin moving distally through the staple receiving slots 2141.The staples 2142 that are maintained within the staple receiving slots2141 of the stapler cartridge 214 are thereby pushed through the sectionof clamped tissue and into the staple guides 2026 of the clamping face2023 of the anvil endcap 202 until the staples 2142 are closed.

Upon the staples 2142 being fully closed, the clamping force on thesection of tissue may be reduced by rotation of the second drive shaft32 in the opposite direction. Generally, when the second drive shaft 32is rotated in the opposite direction, the thrust element 228 is caused,via the reverse movement of the components of the staple and bladeportion 106, to also rotate in a direction opposite of that describedabove, thereby causing the staple pusher carriage element 222 to beretracted, e.g., moved proximally. The blade 218 is also caused to beretracted, e.g., moved proximally, by the lip 2181 of the blade 218being engaged within the recess 2224 located on the outer surface of theneck portion 2221 of the staple pusher carriage element 222. Once theclamping force between the clamping face 2023 of the anvil endcap 202and the clamping face 2146 of the staple cartridge 214 has beensufficiently reduced, the section of tissue that has been cut andstapled is removed from between the clamping face 2023 of the anvilendcap 202 and the clamping face 2146 of the staple cartridge 214, andthe surgical attachment 100 may be removed from within the patient.

FIGS. 12( a) to 12(c) illustrate some components of a cutting andstapling component, according to another embodiment of the presentinvention. Specifically, FIG. 12( a) is a perspective view of a cuttingand stapling component 4103 that includes an staple and blade portion4106. Extending in an axial direction through a centrally disposedopening of the staple and blade portion 4106 is a flexible trocar shaft4108, e.g., a cable. Disposed at a distal end 4108 a of the flexibletrocar shaft 4108 is a cable extension element 4206 that defines atrocar receiving slot 4065. The trocar receiving slot 4065 has a wideportion 4066 at its proximal end and a narrow portion 4067 at its distalend.

The cutting and stapling component 4103 also includes an anvil assembly4112. The anvil assembly 4112 includes an anvil end cap 4202. The anvilend cap 4202 has extending proximally therefrom an anvil sleeve 4208.Extending from a proximal-most end of the anvil sleeve 4208 is aflexible cable 4212 having a trocar 4220 attached thereto. The trocar4220 includes a first portion 4213, e.g., a spherical orb, from whichextends a cylindrical finger 4214. The cylindrical finger 4214 tapers toa trocar tip 4215.

FIG. 12( b) is a side cross-sectional view that illustrates additionalfeatures of the cable extension element 4206. Specifically, the cableextension element 4206 defines an axially-extending central bore 4207with which the narrow portion 4067 and the wide portion 4066 of thetrocar receiving slot 4065 are in communication. Positioned within thecentral bore 4207 and proximal to the trocar receiving slot 4065 is aplunger 4251 that is biased in the distal direction by a biasingelement, e.g., spring, 4250. As shown in FIG. 12( b), the trocar tip4215 is configured to be pushed against and displace the biased plunger4251 such that the first portion 4213, e.g., the spherical orb, of thetrocar 4220 is positioned proximal to the narrow portion 4067 of thetrocar receiving slot 4065.

As shown in FIG. 12( c), once the first portion 4213, e.g., thespherical orb, of the trocar 4220 is positioned proximal to the narrowportion 4067 of the trocar receiving slot 4065, the trocar 4220 islowered through the trocar receiving slot 4065 and into the central bore4207. The plunger 4251 is then biased by the bias element 4250 in thedistal direction so as to seat the first portion 4213 of the trocar 4220at the interface of the wide portion 4258 and the narrow portion 4259 ofthe central bore 4207. The narrow portion 4259 of the central bore 4207retains the trocar 4220 so that, when the trocar shaft 4108 is retractedrelative to the staple and blade portion 4106, the anvil assembly 4112is also retracted.

This embodiment of the cutting and stapling component 4103 provides foran arrangement that facilitates the connection of the trocar shaft 4108to the anvil assembly 4112. Specifically, the flexible cable 4212 of theanvil assembly 4112 and the flexible trocar shaft 4108 enable the anvilassembly 4112 to be more easily connected to the flexible trocar shaft4108. For instance, this arrangement may enable the anvil assembly 4112to be connected to the flexible trocar shaft 4108 without requiring thatthe anvil assembly 4112 be aligned with the flexible trocar shaft 4108prior to such connection and/or with requiring that the tissue limbs inwhich the anvil assembly 4112 and the flexible trocar shaft 4108 arepositioned be aligned prior to such connection. Furthermore, thisarrangement supports high tensile loads, thus enabling the section oftissue that is cut and stapled to be clamped with a greater clampingforce than may be possible in conventional surgical devices. It shouldbe recognized that, while the embodiment shown in FIGS. 12( a) to 12(c)has the trocar 4220 attached to the anvil assembly 4112 and the cableextension element 4206 attached to the trocar shaft 4108, in anotherembodiment, the trocar 4220 may be attached to the trocar shaft 4108 andthe cable extension element 4206 may be attached to the anvil assembly4112.

FIGS. 13( a) to 13(c) illustrate a handle portion, according to anotherembodiment of the present invention. Specifically, FIG. 13( a) is afront perspective view, and FIG. 13( b) is a rear perspective view, of ahandle portion 5102 including a housing 5301. At a proximal end 5301 aof the housing 5301 is disposed a gear housing 5302. At a distal end5301 b of the housing 5301 there extends an insertion tube 5305.Extending from the gear housing 5302 is a quick connect coupling 5304and a tube 5308.

The quick-connect coupling 5304 is mounted onto the gear housing 5302and may be biased, e.g., via a set of springs. The gear housing 5302includes a first drive socket 5304 a and a second drive socket 5304 b.FIG. 13( c) is an exploded front perspective view of the handle portion5102. As shown in FIG. 13( c), the gear housing 5302 mates with a gearretaining plate 5401 so as to maintain the remaining gear components inrelative position. The first drive socket 5304 a includes a first inputelement 5306 a, one end 5061 of which extends through an opening 5021 ofthe gear housing 5302. A first spur gear 5310 has an internal bore 5101and circumferentially-disposed spur gear teeth 5102. A second end 5062of the first input element 5306 a extends, e.g., non-rotatably, throughthe internal bore 5101 of the first spur gear 5310. The teeth 5102 ofthe first spur gear 5310 engage a gear nut 5410 having an internallythreaded axially-extending bore 5411 into which the first drive shaft104 a of the flexible shaft 104 may be inserted by threaded engagement.The gear nut 5410 seats within a recess 5413 of a gear bearing 5412. Thegear bearing 5412 seats within a recess 5023 of the gear housing 5302. Aneck portion 5415 of the gear bearing 5412 has an internal bore 5416 andextends proximally through an opening 5417 of the gear housing 5302.

The second drive socket 5304 b includes a second input element 5306 b,one end 5064 of which extends through a second opening 5022 of the gearhousing 5302 and the other end 5065 of which includes spur gear teeth5066. Also seated within an internal recess 5024 of the gear housing5302 is a spur gear 5318. The spur gear 5318 has arranged along itsouter radius spur gear teeth 5181 that correspond to the spur gear teeth5066 of the second input element 5306 b. The spur gear 5318 has a bore5182 extending therethrough. Non-rotatably engaged within the bore 5182of the spur gear 5318 is a first end 5161 of a shaft drive element 5316.A second end 5162 of the shaft drive element 5316 is configured tonon-rotatably engage the second drive shaft 104 b of the flexible shaft104, which extends through the insertion tube 5305 and to the second end5162 of the shaft drive element 5316.

In operation, the handle portion 5102 is attached via the quick connectcoupling 5304 to the flexible shaft 20 such that the first rotatabledrive shaft 30 of the flexible shaft 20 is coupled, e.g., non-rotatably,to the first input element 5306 a of the handle portion 5102 and suchthat the second rotatable drive shaft 32 of the flexible shaft 20 iscoupled, e.g., non-rotatably, to the second input element 5306 b of thehandle portion 5102. In the clamping mode, rotation of the firstrotatable drive shaft 30 in a first, e.g., clockwise, direction rotatesthe input element 5306 a in the first direction. By the meshingengagement of the gear teeth 5063 of the first input element 5306 a withthe spur gear teeth 5101 of the spur gear 5310, the spur gear 5310 iscaused to rotate in a second, e.g., counter-clockwise, direction.Rotation of the spur gear 5310 in the second direction causes rotationof the gear nut 5410 in the first direction. By the threaded engagementof the first drive shaft 104 a of the flexible shaft 104 with theinternal bore 5101 of the spur gear 5310, the first drive shaft 104 a ofthe flexible shaft 104, and thus the trocar shaft 108 to which the firstdrive shaft 104 a is attached, is caused to move axially. In thismanner, the trocar shaft 108 may be extended in a first, e.g., distal,direction to a desired distance relative to the staple and blade portion106. Once the trocar 110 is inserted within the trocar receiving slot2065 of the anvil extension rod 206, the trocar shaft 108 may then beretracted by operation of the first rotatable drive shaft 30 in theopposite direction.

In the firing mode of operation, the second rotatable drive shaft 32 maybe rotated in a first, e.g., clockwise, direction, so as to rotate theinput element 5306 b in the first direction. By the meshing engagementof the gear teeth 5066 of the input element 5306 b with the spur gearteeth 5181 of the spur gear 5318, the spur gear 5318 is caused to rotatein a second, e.g., counter-clockwise, direction. Rotation of the spurgear 5318 in the second direction causes the shaft drive element 5316,and the second drive shaft 104 b of the flexible shaft 104 which isnon-rotatably connected to the shaft drive element 316, to rotate in thesecond direction. Rotation of the second drive shaft 104 b of theflexible shaft 104 thereby causes the input element 248 of the stapleand blade portion 106 to which it is non-rotatably coupled to alsorotate in the second direction. In this manner, the staple cartridge 214of the staple and blade portion 106 may be moved relative to the anvilassembly 112 so as to clamp a section of tissue disposed therebetween,and the tissue may be cut and stapled as set forth more fully above.

FIGS. 14( a) to 14(d) and FIGS. 15( a) to 15(d) illustrate a cutting andstapling component according to another embodiment of the invention.Specifically, FIG. 14( a) is a front perspective view and FIG. 14( b) isa rear perspective view that illustrate a cutting and stapling component603 in an assembled and partially closed position. FIG. 14( c) is a sideview and FIG. 14( d) is a rear view that illustrate the cutting andstapling component 603 in the same position and condition. As shown, thecutting and stapling component 603 includes an anvil assembly 612 and astaple and blade portion 606.

FIG. 15( a) is a front exploded view that illustrates the components ofthe anvil assembly 612. The anvil assembly 612 includes an anvil end cap602. The anvil end cap 602 has a centrally-disposed opening 6021arranged in the axial direction. The anvil end cap 602 also includes aradially-disposed slot 6022 on a distal side 6025 of the end cap 602,and a clamping face 6023 on a proximal side 6026 of the anvil end cap602. The clamping face 6023 has recessed portion that forms a bladerepository 6024, the purpose of which is set forth in additional detailbelow. The clamping face 6023 also defines staple guides 6027.

The anvil assembly 612 also includes a pin 604 correspondingcross-sectionally to the slot 6022 of the anvil end cap 602. The anvilassembly 612 also includes a hollow anvil sleeve 608. A distal end 6083of the anvil sleeve 608 corresponds cross-sectionally to the opening6021 of the anvil end cap 602. In addition, the distal end 6083 of theanvil sleeve 608 defines openings 6082 that correspond cross-sectionallyto the anvil pin 604. In a proximal end 6084 of the anvil sleeve 608there is defined a recess 6086 that extends circumferentially around theanvil sleeve 608 and that has a radius that is smaller than the radiusof the other portions of the anvil sleeve 608, including the radius ofseveral radially-disposed teeth 6087 located at the proximal-most end ofthe anvil sleeve 608. The proximal end 6084 of the anvil sleeve 608 alsodefines a plurality, e.g., four, axial slots 6088 that extend throughthe recess 6086 and the teeth 6087, thereby enabling the proximal end6084 of the anvil sleeve 608 to be radially compressed. The anvil sleeve608 also includes one or more axially-disposed keys 6085 on its outersurface.

The anvil assembly 612 also includes an anvil extension rod 606. Theanvil extension rod 606 has a distal end 6061 that may be flat and thatdefines an opening 6062. The anvil extension rod 606 also has a centralregion 6063 that is round and that corresponds cross-sectionally to aninner diameter of the recess 6086 of the anvil sleeve 608. The distalend 6061 of the anvil extension rod 606 is cross-sectionally larger thanthe inner diameter of the recess 6086 of the anvil sleeve 608. The anvilextension rod 606 also has a proximal end 6063 that defines a trocarreceiving slot 6065.

FIG. 15( b) is an exploded, perspective view that illustrates some ofthe components of the staple and blade portion 606, according to oneembodiment of the present invention. As shown in FIG. 15( b), the stapleand blade portion 606 includes a hollow anvil sleeve guide 610. Theinner surface of the anvil sleeve guide 610 includes one or more keyways6101. The outer surface of the anvil sleeve guide 610 includes a lip6102, such that a proximal end 6103 of the anvil sleeve guide 610 has alarger radius than a distal end 6104 of the anvil sleeve guide 610.

The staple and blade portion 606 also includes an outer housing sleeve612. The outer housing sleeve 612 has one or more openings 6121 at itsproximal end 6122, and a radially inwardly-extending lip 6123 at thedistal end 6124 of the outer housing sleeve 612. The staple and bladeportion 106 also includes a staple cartridge 614. The staple cartridge614 defines a plurality of axially-disposed staple receiving slots 6141in which staples 6142 are stored. In the embodiment shown in FIG. 15(b), the staple receiving slots 6141 are disposed circumferentiallyaround the staple cartridge 614 in two radially-spaced apart rows,wherein the staple receiving slots 6141 in the first row overlap thestaple receiving slots 6141 in the second row. The staple cartridge 614also includes a radially inwardly-extending lip 6145 and a radiallyoutwardly-extending lip 6143 located near the proximal end 6144 of thestaple cartridge 614. Furthermore, the distal end 6147 of the staplecartridge 614 defines a clamping face 6146.

The staple and blade portion 606 also includes a frangible bladeprotection ring 616 and a cartridge pusher element 617. The cartridgepusher element 617 has a radially outwardly-extending rib 6171 at itsdistal end. In addition, the staple and blade portion 106 includes ablade 618. The blade 618 has a cutting edge 6183 that extendscircumferentially along its distal end. In addition, the blade 618defines a radially, inwardly-extending tab or lip 6181 at its proximalend.

The staple and blade portion 606 also includes a staple pusher 620. Thestaple pusher 620 has a plurality of axially-disposed pushing teeth6201, each of which corresponds to and aligns with the staple receivingslots 6141 of the stapler cartridge 614. The staple pusher 620 alsoincludes a key 6202 on its outer surface.

The staple and blade portion 606 also includes a staple pusher carriageelement 622 that has a neck portion 6221 and a flange portion 6222, theneck portion 6221 extending axially in a distal direction relative tothe flange portion 6222. An interior surface of the neck portion 6221includes threads 6223, while an exterior surface of the neck portion6221 defines a circumferentially-disposed recess 6224. In addition, theradially outermost edge of the flange 6222 includes a key 6225.

FIG. 15( c) is a perspective view that illustrates the remainingcomponents of the staple and blade portion 606 in an exploded condition,according to one embodiment of the present invention. As shown in FIG.15( c), the staple and blade portion 606 also includes a split ring 624.The split ring 624 includes a pair of semi-circular ring portions 6241and 6242 that when arranged in the shape of a ring define therebetween apair of keyways 6243 and 6244. The staple and blade portion 606 alsoincludes a washer 626. The staple and blade portion 606 also includes athrust element 628 that has a neck portion 6281 and a flange portion6282, the neck portion 6281 extending axially in a distal directionrelative to the flange portion 6282. A bore 6283 is defined within theinterior of the neck portion 6281, while an exterior surface of the neckportion 6281 defines threads 6284 that correspond to the threads 6223located on the interior surface of the neck portion 6221 of the staplepusher carriage element 622. The flange 6282 of the thrust element 628includes one or more bores 6285 within its distally-facing surface, andthree proximally-extending pins 6286 having, e.g., a round crosssection.

The staple and blade portion 606 includes a first spur gear 630 a, asecond spur gear 630 b and a third spur gear 630 c. Each of the first,second and third spur gears 630 a, 630 b, 630 c define an internal bore6301 that corresponds cross-sectionally to a pin 6286 of the thrustelement 628. Each of the first, second and third spur gears 630 a, 630b, 630 c also includes circumferentially-disposed spur gear teeth 6302.

The staple and blade portion 606 also includes a washer 632, and aninner housing sleeve 634. The inner housing sleeve 634 includes aninternal bore 6341 that has a first interior radius at a distal end ofthe inner housing sleeve 634. The internal bore 6341 extends proximallytowards a radially inwardly-extending lip 6345 at which point theinterior radius of the internal bore 6341 is reduced. The internal bore6341 extends still further proximally to a second radiallyinwardly-extending lip 6346 at which point the interior radius of theinternal bore 6341 is again reduced. Proximal to the second lip 6346 aregear teeth 6347 that extend circumferentially along the interior surfaceof the inner housing sleeve 634. A proximal end, e.g., proximal relativeto the gear teeth 6347, has a smooth interior surface, and has one ormore radial openings 6344 defined therein.

The staple and blade portion 606 also includes a sun gear element 636that has a neck portion 6361 and a flange portion 6362, the neck portion6361 extending axially in a distal direction relative to the flangeportion 6362. A bore 6363 is defined within the interior of the neckportion 6361, while an exterior surface of the neck portion 6361 hascircumferentially-disposed gear teeth 6364 that correspond to the gearteeth 6302 of the first spur gear 630. The flange portion 6362 includesthree proximally-extending pins 6366 having, e.g., a round crosssection. The staple and blade portion 606 also includes a washer 638.

The staple and blade portion 606 also includes a first planetary gear640 a, a second planetary gear 640 b and a third planetary gear 640 c.Each of the first, second and third planetary gears 640 a, 640 b, 640 cdefine an internal bore 6401 that corresponds cross-sectionally to a pin6366 of the thrust element 636. Each of the first, second and thirdplanetary gears 640 a, 640 b, 640 c also includescircumferentially-disposed gear teeth 6402.

The staple and blade portion 606 also includes a sun gear 642 having aninternal bore 6421. An exterior surface of the sun gear 242 hascircumferentially-disposed gear teeth 6422 that correspond to the gearteeth 6402 of the first, second and third planetary gears 640 a, 640 band 640 c. The staple and blade portion 606 also includes a secondplanetary gear 646 having an internal bore 6461. An exterior surface ofthe second planetary gear 646 has circumferentially-disposed gear teeth6462 that correspond to circumferentially-disposed gear teeth 6422 ofthe sun gear 642.

The staple and blade portion 606 also includes a input element 648, adistal end 6481 of which has an internal bore 6483, into which isnon-rotatably inserted, e.g., via a square cross-section, a gear element6483. On an outer surface of the gear element 6483 arecircumferentially-disposed gear teeth 6482 that correspond to thecircumferentially-disposed gear teeth 6462 on the exterior surface ofthe second planetary gear 646. A proximal end of the input element 648has a round outer circumference and an internal bore 6485.

The staple and blade portion 606 also includes a housing rear endcap 650having a central bore 6501, a second bore 6502 radially offset relativeto the central bore 6501, and a recess 6503 from which a pin 6504extends in a distal direction. The housing rear endcap 650 also includesan outer radial lip 6505. Located distally relative to the outer radiallip 6505 is at least one opening 6506 defined within a round outercircumferential surface 6507. The housing rear endcap 650 also includesat its proximal end one a radial bore 6509 in communication with thecentral bore 6501.

The staple and blade portion 606 also includes a central rear endcapsleeve 652 having an axial bore 6521 extending therethrough. Inaddition, the central rear endcap sleeve 652 has radial bores 6252extending therethrough. The staple and blade portion 606 also includes apin stop 655 that is sized and shaped to be inserted through radialopenings 6509 of the housing rear end cap 650. The pin stop 655 is alsosized and shaped to be inserted through radial openings 659 of aninsertion tube 658. When the pin stop 655 is simultaneously insertedthrough the radial openings 6509 of the housing rear end cap 650 and theradial openings 659 of the insertion tube 658, the housing rear end cap650 and the insertion tube 658 are fixed in position relative to eachother. The insertion tube 658 is employed to connect the handle portion,e.g., the handle portion 102 illustrated in FIGS. 7( a) to 7(f) or thehandle portion 5102 illustrated in FIGS. 13( a) to 13(c), to the stapleand blade portion, e.g., the staple and blade portion 106 illustrated inFIGS. 9 to 11( b) or the staple and blade portion 606 illustrated inFIGS. 15( a) to 15(c). Advantageously, the insertion tube 6258 is formedof a tissue-compatible, sterilizable elastomeric material. Preferably,the insertion tube 6258 may be formed of a material that isautoclavable. In addition, the insertion tube 6258 may be formed of amaterial having a high or relatively high lubricity. For instance, theinsertion tube 6258 may be formed of a material such as Teflon™ (i.e., afluoropolymer, e.g., polytetrafluoroethylene “PTFE”), silicone, aTeflon™/silicone combination, such as, for example, SIL-KORE™ (made byW.L. Gore & Associates), “EPTFE”, e.g., expanded teflon, etc. Othersuitable materials that may be employed are described in further detailin Applicants' co-pending U.S. patent application Ser. No. 10/099,634,filed on Mar. 15, 2002, which as previously mentioned is expresslyincorporated herein by reference in its entirety.

FIG. 15( d) is a side cross-sectional view that illustrates some of thecomponents of the staple and blade portion 606 in an assembledcondition. The components of the staple and blade portion 606 not shownin FIG. 15( d) are generally arranged in a manner similar to thearrangement of the staple and blade portion 106 shown in FIGS. 11( a)and 11(b). Referring to FIG. 15( d), the thrust element 628 (shownpartially here for clarity) is rotatably mounted on the anvil sleeveguide 610 (not shown). The staple pusher carriage element 622 is mountedon the thrust element 628 such that the threads 6223 located on theinterior surface of the neck portion 6221 of the staple pusher carriageelement 622 are in threaded engagement with the threads 6284 located onthe exterior surface of the neck portion 6281 of the thrust element 628.The staple pusher carriage element 622 is axially slidable within theouter housing sleeve 612.

Abutting the flange 6222 of the staple pusher carriage element 622 isthe staple pusher 620. The staple pusher 620 is axially slidable withinthe outer housing sleeve 612. The pushing teeth 6201 of the staplepusher 620 extend distally and align with the staple receiving slots6141 of the staple cartridge 614.

The staple cartridge 614 is positioned distally relative to the staplepusher 620 and is maintained within the interior of the outer housingsleeve 612. The staple cartridge 614 is axially moveable in a distaldirection within the outer housing sleeve 612 from the position shown inFIG. 14 until the radially, outwardly-extending lip 6143 of the staplecartridge 614 abuts the radially, inwardly-extending lip 6123 of theouter housing sleeve 612.

Located between the staple pusher 620 and the staple pusher carriageelement 622 is the blade 618. The radially, inwardly-extending tab orlip 6185 located at the distal end of the blade is engaged within therecess 6224 located on the outer surface of the neck portion 6221 of thestaple pusher carriage element 622. The cutting edge 6183 of the blade618 is sheathed within the frangible blade protection ring 616. Aproximal end of the frangible blade protection ring 616 abuts theradially inwardly-extending lip 6144 of the staple cartridge 614.

A staple cartridge pusher 617 is positioned along the blade 618 suchthat the proximal end of the staple cartridge pusher 617 abuts thestaple pusher 620. The radially outwardly-extending rib 6171 of thestaple cartridge pusher 617 abuts the radially inwardly-extending lip6145 of the staple cartridge 614. The radially outwardly-extending rib6171 of the staple cartridge pusher 617 is sized and shaped such that,initially, the radially outwardly-extending rib 6171 of the staplecartridge pusher 617 is larger than the distance between the radiallyinwardly-extending lip 6145 of the staple cartridge 614 and the outersurface of the blade 618.

In operation, the components of the staple and blade portion 606 notshown in FIG. 15( d) generally operate in a manner similar to theoperation of those components of the staple and blade portion 106 shownin FIGS. 11( a) and 11(b), as set forth more fully above. Referring toFIG. 15( d), the thrust element 628 is caused to rotate around the anvilsleeve guide 610 by, e.g., operation by the user of the first rotatabledrive shaft 30 of the flexible shaft 20 in, e.g., a second direction.

The rotation of the thrust element 628 in the second direction aroundthe anvil sleeve guide 610 causes the staple pusher carriage element622, by virtue of the threads 6284 located on the exterior surface ofthe neck portion 6281 of the thrust element 628 being in threadedengagement with the threads 6223 located on the interior surface of theneck portion 6221 of the staple pusher carriage element 622, to moverelative to the thrust element 628. Because the keys 6225 of the staplepusher carriage element 622 are engaged within the keyways 6243 formedby the split ring 624, the staple pusher carriage element 622 is causedto axially slide within the split ring 624 in the distal direction. Thedistal movement of the staple pusher carriage element 622 causes thestaple pusher 620, by virtue of the abutment of the flange 6282 of thethrust element 628 with the staple pusher 620, to also move in thedistal direction.

Movement of the staple pusher 620 in the distal direction causes theblade 618, and the frangible blade protection ring 616 that covers thecutting edge 6183 of the blade 618, to also move along with the staplepusher 620 in the distal direction. Furthermore, because the radiallyoutwardly-extending rib 6171 of the staple cartridge pusher 617 isinitially larger than the distance between the radiallyinwardly-extending lip 6145 of the staple cartridge 614 and the outersurface of the blade 618, movement of the staple pusher 620 in thedistal direction also causes the staple cartridge 614 to move along withthe staple pusher 620 in the distal direction. Thus, at this stage ofoperation, the staple pusher 620, the blade 618, the frangible bladeprotection ring 616, the cartridge pusher element 617 and the staplecartridge 614 move distally together. The staple cartridge 614 movesdistally so as to clamp a section of tissue (not shown) between theclamping face 6023 of the anvil endcap 602 and the clamping face 6146 ofthe staple cartridge 614. Depending on the thickness of the section oftissue, the staple cartridge 614 may move distally until the radiallyoutwardly-extending lip 6143 of the staple cartridge 614 abuts theradially, inwardly-extending lip 6123 of the outer housing sleeve 612.

Once the staple cartridge 614 has been moved distally sufficiently toclamp a section of tissue, the frangible blade protection ring 616 andthe staple cartridge 614 are prevented from further distal movement bycontact with a compressed section of tissue. Continued operation of thesecond rotatable drive shaft 32 eventually causes, e.g., upon theexertion of approximately 70 lbs. or more of pressure on the clampedsection of tissue, the radially outwardly-extending rib 6171 of thestaple cartridge pusher 617 to be pushed between the radiallyinwardly-extending lip 6145 of the staple cartridge 614 and the outersurface of the blade 618, thereby overcoming the interference fitbetween these components. At this point, the staple cartridge 614 doesnot move distally but instead, the staple pusher 620 and the blade 618are caused to continue to move distally relative to the staple cartridge614. This continued distal movement of the blade 618 causes the cuttingedge 6183 of the blade 618 to penetrate the frangible blade protectionring 616 and to thereby cut the section of tissue that has been clamped.Simultaneously, further distal movement of the staple pusher 620 causesthe pushing teeth 6201 of the staple pusher 620, which are aligned withthe staple receiving slots 6141 of the stapler cartridge 614, to beginmoving distally through the staple receiving slots 6141. The staples6142 that are maintained within the staple receiving slots 6141 of thestapler cartridge 614 are thereby pushed through the section of clampedtissue and into the staple guides 6026 of the clamping face 6023 of theanvil endcap 602 until the staples 6142 are closed.

Upon the staples 6142 being fully closed, the clamping force on thesection of tissue may be reduced by rotation of the second drive shaft32 in the opposite direction. Generally, when the second drive shaft 32is rotated in the opposite direction, the thrust element 628 is caused,via the reverse movement of the components of the staple and bladeportion 106, to also rotate in a direction opposite of that describedabove, thereby causing the staple pusher carriage element 622 to beretracted, e.g., moved proximally. The blade 618 is also caused to beretracted, e.g., moved proximally, by the lip 6185 of the blade 618being engaged within the recess 6224 located on the outer surface of theneck portion 6221 of the staple pusher carriage element 622. Inaddition, the staple cartridge 614 is caused to be retracted by theinterference fit of the radially outwardly-extending rib 6171 of thestaple cartridge pusher 617 maintained between the radiallyinwardly-extending lip 6145 of the staple cartridge 614 and the outersurface of the blade 618. Once the clamping force between the clampingface 6023 of the anvil endcap 602 and the clamping face 6146 of thestaple cartridge 614 has been sufficiently reduced, the section oftissue that has been cut and stapled may be removed from between theclamping face 6023 of the anvil endcap 602 and the clamping face 6146 ofthe staple cartridge 614, and the surgical attachment 600 may be removedfrom within the patient.

FIG. 16 is a side cross-sectional view that illustrates schematicallysome components of a surgical attachment 700 in accordance with anotherembodiment of the present invention. The surgical attachment 700includes an anvil endcap 702 that is connected to a trocar shaft 708,e.g., a cable. The anvil endcap 702 includes a clamping face 7023. Theclamping face 7023 has recessed portion that forms a blade repository7024. The clamping face 7023 also defines staple guides 7026. The trocarshaft 708 extends through a staple and blade portion 706 and is moveablerelative to the staple and blade portion 706 by the trocar shaft 708being extended and retracted, e.g., by operation of a rotatable driveshaft such as the first rotatable drive shaft 30 shown and described inconnection with FIG. 1.

The staple and blade portion 706 includes a outer housing sleeve 712that is fixedly connected at its proximal end to a housing rear end cap750 and that is fixedly connected at its distal end to a staplecartridge 714. The staple cartridge 714 defines a plurality of staplereceiving slots 7141 in which staples 7142 are disposed. The staplereceiving slots 7141 are configured so as to correspond to and bealigned with the staple guides 7026 defined in the clamping face 7023 ofthe anvil endcap 702. The distal end of the staple cartridge 714 definesa clamping face 7146 which has one or more distal protrusions 7147.

The staple and blade portion 706 also includes a staple pusher 720having staple pusher fingers 7201 that are configured so as tocorrespond to and be aligned with the staple receiving slots 7141 of thestaple cartridge 714. Mounted at a distal end of the staple pusher 720is a blade 718. At a proximal end of the staple pusher 720 are shearpins 751 which, at least initially, connect the staple pusher 720 to thehousing rear end cap 750.

In operation, a section of tissue, such as a section of oral tissue thatis desired to be cut and stapled, is disposed between the clamping face7023 of the anvil endcap 702 and the clamping face 7146 of the staplecartridge 714. Upon operation of a suitable drive mechanism, e.g., thefirst rotatable drive shaft 30, the trocar shaft 708 is retractedrelative to the staple and blade portion 706 until the section of tissueis sufficiently clamped between the clamping face 7023 of the anvilendcap 702 and the clamping face 7146 of the staple cartridge 714. Oncethe section of tissue is sufficiently clamped between the clamping face7023 of the anvil endcap 702 and the clamping face 7146 of the staplecartridge 714, continued operation of the suitable drive mechanism,e.g., the first rotatable drive shaft 30, causes the shear pins 751 toshear. Advantageously, the pressure at which the shear pins 751 shear ispredetermined to be a pressure at which the section of tissue isoptimally clamped prior to being cut and stapled. Once the shear pins751 are caused to shear, the staple cartridge 714, along with the outerhousing sleeve 712 and the housing rear end cap 750, is permitted tomove proximally relative to the staple pusher 720. Proximal movement ofthe staple cartridge 714 relative to the staple pusher 720 causes thestaple pusher fingers 7201 of the staple pusher 720 to move through therespective staple receiving slots 7141 of the staple cartridge 714. Bycontinued operation of the suitable drive mechanism, e.g., the firstrotatable drive shaft 30, the staples 7142 are gradually pushed out ofthe staple receiving slots 7141 of the staple cartridge 714, through thesection of tissue and against the staple guides 7026 of the anvil endcap702 until the staples 7142 are closed. In addition, and generallysimultaneously, once the shear pins 751 are caused to shear, the staplecartridge 714 is caused to move proximally relative to the blade 718mounted at the distal end of the staple pusher 720. Proximal movement ofthe staple cartridge 714 relative to the blade 718 causes the blade 718to penetrate the section of tissue clamped between the clamping face7023 of the anvil endcap 702 and the clamping face 7146 of the staplecartridge 714. By continued operation of the suitable drive mechanism,e.g., the first rotatable drive shaft 30, the blade 718 is graduallypushed through the section of tissue and into the blade repository 7024of the anvil endcap 702 until the section of tissue is completely cut.

Thus, the surgical attachment 700, in accordance with one embodiment ofthe present invention, provides an arrangement in which the staplepusher 720, the staples 7142 and the blade 718 are held in a relativelystationary position. The anvil assembly 712 is caused to be movedrelative to the staple pusher 720, the staples 7142 and the blade 718 soas to cut and staple the section of tissue disposed therebetween. Thisarrangement may provide for improved performance due to the increasedclamping forces that may be applied as compared to conventional circularcutting and stapling devices. These increased clamping forces may bepossible because, unlike conventional circular cutting and staplingdevices that employ a gear arrangement or the like to push a staplepusher, staples and a blade against a stationary anvil, the surgicalattachment 700 provides an arrangement in an anvil assembly is pulledtowards and against a staple pusher, staples and a blade that are heldin a relative stationary position.

FIG. 17 is a side cross-sectional view that illustrates schematicallysome components of a surgical attachment 800 in accordance with anotherembodiment of the present invention. The surgical attachment 800includes an anvil endcap 802 that is connected to a trocar shaft 808,e.g., a cable. The anvil endcap 802 includes a clamping face 8023. Theclamping face 8023 is not perpendicular, e.g., sloped, relative to anaxis 880 defined by the trocar shaft 808. The clamping face 8023 has arecessed portion that forms a blade repository 8024. The clamping face8023 also defines staple guides 8026. The trocar shaft 808 extendsthrough a staple and blade portion 806 and is moveable relative to thestaple and blade portion 806 by the trocar shaft 808 being extended andretracted, e.g., by operation of a rotatable drive shaft such as thefirst rotatable drive shaft 30 shown and described in connection withFIG. 1.

The staple and blade portion 806 includes a staple cartridge 814. Thestaple cartridge 814 defines a plurality of staple receiving slots 8141in which staples 8142 are disposed. The staple receiving slots 8141 areconfigured so as to correspond to and be aligned with the staple guides8026 defined in the clamping face 8023 of the anvil endcap 802. Thedistal end of the staple cartridge 814 defines a clamping face 8146. Theclamping face 8146 is not perpendicular, e.g., sloped, relative to theaxis 880 defined by the trocar shaft 808. Preferably, the clamping face8023 is shaped and oriented so as to be parallel to the clamping face8023 of the anvil endcap 802.

The staple and blade portion 806 also includes a staple pusher 820having staple pusher fingers 8201 that are configured so as tocorrespond to and be aligned with the staple receiving slots 8141 of thestaple cartridge 814. Mounted at a distal end of the staple pusher 820is a blade 818.

in operation, a section of tissue, such as a section of oral tissue thatis desired to be cut and stapled, is disposed between the clamping face8023 of the anvil endcap 802 and the clamping face 8146 of the staplecartridge 814. Upon operation of a suitable drive mechanism, e.g., thefirst rotatable drive shaft 30, the trocar shaft 808 is retractedrelative to the staple and blade portion 806 until the section of tissueis sufficiently clamped between the clamping face 8023 of the anvilendcap 802 and the clamping face 8146 of the staple cartridge 814. Themechanical arrangement by which operation of the suitable drivemechanism, e.g., the first rotatable drive shaft 30, causes the trocarshaft 808 to be retracted relative to the staple and blade portion 806may be a gear arrangement such as described hereinabove, or may be anyother suitable mechanical arrangement. Once the section of tissue issufficiently clamped between the clamping face 8023 of the anvil endcap802 and the clamping face 8146 of the staple cartridge 814, continuedoperation of the suitable drive mechanism, e.g., the first rotatabledrive shaft 30, causes the staple cartridge 814 and the staple pusher820 to move relative to each other. This relative movement may befacilitated by the staple pusher 820 being pushed relative to the staplecartridge 814 by a suitable drive mechanism, some examples of which aredescribed hereinabove, or may be facilitated by the anvil endcap 802being pulled relative to the staple pusher 820, such as described abovein connection with FIG. 16. Any other mechanical arrangement may also beemployed for this purpose. Movement of the staple cartridge 814 relativeto the staple pusher 820 causes the staple pusher fingers 8201 of thestaple pusher 820 to move through the respective staple receiving slots8141 of the staple cartridge 814. By continued operation of the suitabledrive mechanism, e.g., the first rotatable drive shaft 30, the staples8142 are gradually pushed out of the staple receiving slots 8141 of thestaple cartridge 814, through the section of tissue and against thestaple guides 8026 of the anvil endcap 802 until the staples 8142 areclosed. In addition, and generally simultaneously, movement of thestaple cartridge 814 relative to the blade 818, which is mounted at thedistal end of the staple pusher 820, causes the blade 818 to penetratethe section of tissue clamped between the clamping face 8023 of theanvil endcap 802 and the clamping face 8146 of the staple cartridge 814.By continued operation of the suitable drive mechanism, e.g., the firstrotatable drive shaft 30, the blade 818 is gradually pushed through thesection of tissue and into the blade repository 8024 of the anvil endcap802 until the section of tissue is completely cut.

The surgical attachment 800, in accordance with one embodiment of thepresent invention, provides an arrangement in which the staple and bladeportion 806 may be inserted more easily into a patient's body. Inconventional circular cutting and stapling devices, the staple and bladeportion typically has a perpendicularly-arranged clamping face, e.g., aclamping face that is perpendicular to the general axis defined by thestaple and blade portion or by the trocar shaft passing through thestaple and blade portion. This perpendicularly-arranged clamping facemeets the outer housing of the staple and blade portion at acircumferential edge which, in cross-section, is essentially a rightangle. When inserted into a patient, particularly an oral passage of apatient that has a very small cross-sectional area, the circumferentialedge formed by the perpendicularly-arranged clamping face and the outerhousing of the staple and blade portion rub against the internal surfaceof the oral passage and thereby make insertion difficult. Furthermore,the rubbing of the circumferential edge against the internal surface ofthe oral passage may damage the oral passage. In contrast, thenon-perpendicular, e.g., sloped, arrangement of the clamping face 8146of the staple cartridge 814 reduces the degree of rubbing against theinternal surface of the oral passage that is experienced, thereby easinginsertion of the staple and blade portion 806 through the oral passageand reducing the likelihood of injury to the internal surface of theoral passage.

FIGS. 18( a) and 18(b) illustrate a staple and blade portion, accordingto another embodiment of the present invention. Specifically, FIG. 18(a) is an exploded, perspective view that illustrates some of thecomponents of a staple and blade portion 906. As shown in FIG. 18( a),the staple and blade portion 906 includes an outer housing sleeve 904.The outer housing sleeve 904 has a gear housing 9043, defining an axialbore 9042 and a second bore 9044, at its proximal end. The outer housingsleeve 904 also has a keyway 9041 that extends longitudinally along itsinner surface.

The staple and blade portion 906 also includes an input shaft 902 thatis configured to be non-rotatably connected to a drive shaft, e.g.,second rotatable drive shaft 104 b of the flexible shaft 104, which inturn may be connected via a handle portion, e.g., the handle portion 102to the second rotatable drive shaft 32 of the flexible shaft 20. Thedistal end of the input shaft 902 has an extension which isnon-rotatably insertable, e.g., via a square cross-section of theextension, into an input gear 906. On an outer surface of the input gear906 are circumferentially-disposed gear teeth 9061.

The staple and blade portion 906 also includes a sun gear 908 having acentral bore 9081. An exterior surface of the sun gear 908 hascircumferentially-disposed gear teeth 9082 that correspond to the gearteeth 9061 of the input gear 906. The staple and blade portion 906 alsoincludes a washer 910. The staple and blade portion 906 also includes aring gear 912. The ring gear 912 has gear teeth 9121 that extendcircumferentially along the interior surface of the ring gear 912.

The staple and blade portion 906 also includes a first planetary gear914 a, a second planetary gear 914 b and a third planetary gear 914 c.Each of the first, second and third planetary gears 914 a, 914 b, 914 cdefine an internal bore 9141. In addition, each of the first, second andthird planetary gears 914 a, 914 b, 914 c also includescircumferentially-disposed gear teeth 9142.

The staple and blade portion 906 also includes a spider screw element916 that has a neck portion 9162 and a flange portion 9161, the neckportion 9162 extending axially in a distal direction relative to theflange portion 9162. A central bore 9166 extends through the spiderscrew element 916. An exterior surface of the neck portion 9162 definesthreads 9164. In addition, the exterior surface of the neck portion 9162defines longitudinally-extending keyways 9165. The flange portion 9161of the spider screw element 916 includes three proximally-extending pins9163 having a cross section, e.g., round, that corresponds to the bores9141 of the first, second and third planetary gears 914 a, 914 b, 914 c.

The staple and blade portion 906 also includes a nut 918 having agenerally flat, disk-shaped configuration. The nut 918 has a centralbore 9181 extending therethrough. The central bore 9181 defines threads9182 that correspond to the threads 9164 on the exterior surface of theneck portion 9162 of the spider screw element 916. A distal face of thenut 918 defines a circumferential groove 9183. In addition, the outerradial edge of the nut 918 defines a key 9184 that corresponds in sizeand shape to the keyway 9041 on the internal surface of the outerhousing sleeve 904.

The staple and blade portion 906 also includes a rotary pusher 920 thatalso has a generally flat, disk-shaped configuration. The rotary pusher920 has a central bore 9201 extending therethrough. The central bore9181 defines keys 9202 that correspond in size and shape to the keyways9165 extending longitudinally on the neck portion 9162 of the spiderscrew element 916. A proximal face of the rotary pusher 920 defines acircumferential groove 9204 that is aligned with the circumferentialgroove 9183 on the distal face of the nut 918. On a distal face of therotary pusher 920 there is disposed a pusher cam 9203.

In addition, the staple and blade portion 906 includes a blade 922. Theblade 922 has a cutting edge 9221 that extends circumferentially alongits distal end. The staple and blade portion 906 also includes a staplecartridge 924. The staple cartridge 924 defines a plurality ofaxially-disposed staple receiving slots 9241 in which staples 9242 arestored. In the embodiment shown in FIG. 18( a), the staple receivingslots 9241 are disposed circumferentially around the staple cartridge924 in two radially-spaced apart rows, wherein the staple receivingslots 9241 in the first row overlap the staple receiving slots 9241 inthe second row. Furthermore, the distal end of the staple cartridge 924defines a clamping face 9243.

The staple and blade portion 906 also includes a staple pusher 928. Thestaple pusher 928 has a plurality of axially-disposed pushing teeth9281, each of which corresponds to and aligns with the staple receivingslots 9241 of the stapler cartridge 924. The staple pusher 928 alsoincludes a key 9202 on its outer surface.

FIG. 18( b) is a side cross-sectional view that illustrates thecomponents of the staple and blade portion 906 in an assembledcondition. The input shaft 902 extends through and is configured torotate within the second bore 9044 of the gear housing 9043. The inputgear 906 is mounted on and non-rotatably connected to the distal end ofthe input shaft 902. The sun gear 908 is seated within the proximal endof the outer housing sleeve 904 such that a distally-extendingcylindrical core 9045 of the outer housing sleeve 904 is insertedthrough the central bore 9081 of the sun gear 908. Thecircumferentially-disposed gear teeth 9061 on the outer surface of theinput gear 906 are in meshing engagement with thecircumferentially-disposed gear teeth 9082 of the sun gear 908. The ringgear 912 is fixed within the proximal end of the outer housing sleeve904. The first, second and third planetary gears 914 a, 914 b, 914 c arepositioned radially between the sun gear 908 and the ring gear 912, suchthat the circumferentially-disposed gear teeth 9142 of the first, secondand third planetary gears 914 a, 914 b, 914 c are in meshing engagementwith the gear teeth 9121 that extend circumferentially along theinterior surface of the ring gear 912 and with the gear teeth 9082 ofthe sun gear 908. The washer 910 abuts the proximal side of the first,second and third planetary gears 914 a, 914 b, 914 c and the distal sideof the input gear 906 so as to prevent axial movement of thesecomponents.

The pins 9163 extending from the flange portion 916 of the spider screwelement 916 are inserted in the internal bores 9141 of the first, secondand third planetary gears 914 a, 914 b, 914 c and thereby maintain thecircumferential spacing of the first, second and third planetary gears914 a, 914 b, 914 c. Thus, the flange portion 9161 of the spider screwelement 916 abuts the distal side of the first, second and thirdplanetary gears 914 a, 914 b, 914 c.

The neck portion 9162 of the spider screw element 916 extends distallythrough the central bore 9181 of the nut 918 such that the threads 9164on the exterior surface of the neck portion 9162 are in threadedengagement with the threads 9182 within the central bore 9181 of the nut918. The key 9184 of the nut 918 is engaged within the keyway 9041 inthe internal surface of the outer housing sleeve 904.

The neck portion 9162 of the spider screw element 916 also extendsdistally through the central bore 9201 of the rotary pusher 920. Thekeys 9202 in the central bore 9201 of the rotary pusher 920 are engagedwithin the keyways 9165 in the neck portion 9162 of the spider screwelement 916. In addition, a set of ball bearings 926 are positioned inthe circumferential grooves 9183 and 9204 of the nut 918 and the rotarypusher 920, respectively, and provide for a generally frictionlesscontact between the nut 918 and the rotary pusher 920.

The neck portion 9162 of the spider screw element 916 also extendsdistally through the center of the staple pusher 928 and the blade 922.The proximal ends of the blade 922 and the staple pusher 928 abut thedistal face of the rotary pusher 920. the rotary pusher 920. The pusherfingers 9281 of the staple pusher 928 extend distally and are alignedwith the staple receiving slots 9241 of the staple cartridge 924. Thestaple cartridge 924 is positioned within the distal end of the outerhousing sleeve 904, the clamping face 9243 of which forms the distalface of the staple and blade portion 906.

In operation, a section of tissue, such as a section of oral tissue thatis desired to be cut and stapled, is disposed between the clamping faceof an anvil assembly, such as an anvil assembly set forth more fullyhereinabove, and the clamping face 9243 of the staple cartridge 924.Upon operation of a suitable drive mechanism, e.g., the first rotatabledrive shaft 30, a trocar shaft, e.g., a cable, that extends through thestaple and blade portion 906 is retracted relative to the staple andblade portion 906 until the section of tissue is sufficiently clampedbetween the respective clamping faces. The mechanical arrangement bywhich operation of the suitable drive mechanism, e.g., the firstrotatable drive shaft 30, causes the trocar shaft to be retractedrelative to the staple and blade portion 906 may

be a gear arrangement such as described hereinabove, or may be any othersuitable mechanical arrangement.

Referring to FIG. 18( b), the input shaft 902 may be connected to adrive shaft, e.g., the second rotatable drive shaft 104 b of theflexible shaft 104. The drive shaft may in turn be connected via ahandle portion, e.g., the handle portion 102, to the second rotatabledrive shaft 32 of the flexible shaft 20. Rotation of the drive shaft ina first direction, e.g., clockwise, causes the input shaft 902 to rotatein the first direction within the second bore 9044 of the gear housing9043. By the non-rotatable connection of the distal end of the inputshaft 902 with the input gear 906, rotation of the input shaft 902 inthe first direction causes the input gear 906 to also rotate in thefirst direction.

By the meshing engagement of the circumferentially-disposed gear teeth9061 of the input gear 906 with the circumferentially-disposed gearteeth 9082 of the sun gear 908, rotation of the input gear 906 in thefirst direction causes the sun gear 908 to rotate around thedistally-extending cylindrical core 9045 within the outer housing sleeve904 in a second direction, e.g., counter-clockwise. Furthermore, by themeshing engagement of the circumferentially-disposed gear teeth 9142 onthe outer surfaces of the first, second and third planetary gears 914 a,914 b and 914 c with the circumferentially-disposed gear teeth 9082 ofthe sun gear 908, rotation of the sun gear 908 in the second directioncauses the first, second and third planetary gears 914 a, 914 b and 914c to rotate in the first direction. Because thecircumferentially-disposed gear teeth 9142 on the outer surfaces of thefirst, second and third planetary gears 914 a, 914 b and 914 c are alsoin meshing engagement with the gear teeth 9121 that extendcircumferentially along the interior surface of the ring gear 912, andbecause the ring gear 912 is rotationally fixed within the proximal endof the outer housing sleeve 904, the rotation of the first, second andthird planetary gears 914 a, 914 b and 914 c in the first directionresults in the first, second and third planetary gears 914 a, 914 b and914 c revolving around the sun gear 908 in the second direction.

Since the pins 9163 extending from the flange portion 916 of the spiderscrew element 916 are inserted in the internal bores 9141 of the first,second and third planetary gears 914 a, 914 b, 914 c, the revolvingmotion of the first, second and third planetary gears 914 a, 914 b and914 c around the sun gear 908 in the second direction causes the spiderscrew element 916 to also rotate in the second direction. By thethreaded engagement of the threads 9164 on the exterior surface of theneck portion 9162 with the threads 9182 within the central bore 9181 ofthe nut 918, and because the key 9184 of the nut 918 is engaged withinthe keyway 9041 in the internal surface of the outer housing sleeve 904,rotation of the spider screw element 916 in the second direction causesthe nut 918 to advance distally along the neck portion 9162 of thespider screw element 916.

Because the keys 9202 in the central bore 9201 of the rotary pusher 920are engaged within the keyways 9165 in the neck portion 9162 of thespider screw element 916, the rotation of the spider screw element 916in the second direction causes the rotary pusher 920 to be rotated inthe second direction. The proximal side of the rotary pusher 920 is incontact with the distal side of the nut 918, and thus the distaladvancement of the nut 918 along the neck portion 9162 of the spiderscrew element 916 causes the rotary pusher 920 to also advance distallyalong the neck portion 9162 of the spider screw element 916. The set ofball bearings 926 positioned in the circumferential grooves 9183 and9204 of the nut 918 and the rotary pusher 920, respectively, provide fora generally frictionless contact between the nut 918, which is notrotating, and the rotary pusher 920, which is rotating.

The distal advancement of the rotary pusher 920 along the neck portion9162 of the spider screw element 916 causes the blade 922 to be moveddistally through the central bore 9244 of the staple cartridge 924 tocut a section of tissue that is disposed between the clamping face 9243of the staple cartridge 924 and the clamping face of an anvil assembly(not shown), such as previously set forth hereinabove. Furthermore, thedistal advancement of the rotary pusher 920 along the neck portion 9162of the spider screw element 916 causes the pusher cam 9203 of the rotarypusher 920 to push the staple pusher element 928 in the distaldirection. Since the rotary pusher 920 is simultaneously rotating whileit is being distally advanced, the pusher cam 9203 is caused tosequentially contact and push against the staple pusher fingers 9281 ofthe staple pusher 928. Specifically, as the rotary pusher 920 isgradually rotated around the neck portion 9162 of the spider screwelement 916, the pusher cam 9203 contacts and pushes against a first ofthe staple pusher fingers 9281, then a second of the staple pusherfingers 9281, etc. After a complete rotation of the rotary pusher 920around the neck portion 9162 of the spider screw element 916, the pushercam 9203 has contacted and pushed against all of the staple pusherfingers 9281 of the staple pusher 928. Depending on the height of thepusher cam 9203 relative to the distal side of the rotary pusher 920 andon the length of the prongs of the staples 9242, once the pusher cam9203 contacts the staple pusher 928, several complete rotations of therotary pusher 920 may be required in order for the pusher cam 9203 topush the staples completely out of the slots 9241 of the staplecartridge 924 and for the staples 9242 to be completely closed againststaple guides of the anvil assembly (not shown).

As previously mentioned, one of the problems that is experienced duringthe use of surgical devices that are inserted within a patients' body,particularly conventional cutting and stapling devices, is that they arerequired to be inserted into orifices or passages of a patient having arelatively small cross-section, e.g., an oral passage of a patient.Thus, insertion of the surgical device may be difficult or impossibleand/or may damage the internal surface of the oral passage. According toone embodiment of the present invention, in order to ease insertion of asurgical device into and through a small orifice or passage of apatient, there may be employed a sleeve. For instance, FIGS. 19( a) to19(e) illustrate various sleeves that may be employed to facilitate theinsertion of a surgical device into and through a small orifice orpassage of a patient.

FIG. 19( a) is an exploded, perspective view of a sleeve 8000 that isconfigured to cover a surgical device, e.g., a circular cutting andstapling device, during insertion into patient's body, according to oneembodiment of the present invention. Advantageously, the sleeve 8000generally has a size and a shape and/or contour that is similar to thesize and shape and/or contour of the surgical device that is coveredthereby. For the purposes of example only, the sleeves describedhereinbelow are recited for use in connection with the surgicalattachment 100, although it should be recognized that the sleeves may beemployed to cover any type of surgical device. Furthermore, for thepurposes of example only, the sleeves described hereinbelow aredescribed as being employed to cover a surgical device for insertionwithin an oral passage of a patient, although it should be recognizedthat the sleeves may be employed to cover the insertion of a surgicaldevice into any type of orifice or passage of a patient.

The sleeve 8000 may be formed of a tissue-compatible, sterilizableelastomeric material. Preferably, the sleeve 8000 may be formed of amaterial that is autoclavable. In addition, the sleeve 8000 may beformed of a material having a high or relatively high lubricity. Forinstance, the sleeve 8000 may be formed of a material such as Teflon™(i.e., a fluoropolymer, e.g., polytetrafluoroethylene “PTFE”), silicone,a Teflon™/silicone combination, such as, for example, SIL-KORE™ (made byW.L. Gore & Associates), “EPTFE”, e.g., expanded teflon, etc. Othersuitable materials that may be employed are described in further detailin Applicants' co-pending U.S. patent application Ser. No. 10/099,634,filed on Mar. 15, 2002, which as previously mentioned is expresslyincorporated herein by reference in its entirety.

The sleeve 8000 includes one or more closure elements, such as theclosure elements 8020 and 8022, that are configured to be selectivelyadjusted between an insertion position and a retracted position. Thesleeve 8000 also includes a distal portion 8024. The distal portion 8024may be configured to cover a distal portion of a surgical device, e.g.,the staple and blade portion 106 or any other distal portion of asurgical device. The sleeve 8000 may also include a proximal portion8026. The proximal portion 8026 may be configured to cover a proximalportion of a surgical device. For instance, the proximal portion 8026 ofthe sleeve 8000 may be configured to cover a flexible shaft, e.g., theflexible shaft 20 or the flexible shaft 104 that are shown and describedin connection with FIG. 1, or a handle portion, e.g., the handle portion102 that is shown and described in connection with FIG. 7( a) or thehandle portion 5102 that is shown and described in connection with FIG.13( a). A ring introducer element 8010 may be connected to the proximalportion 8026 of the sleeve 8000 and may function to facilitate insertionof the surgical device within the sleeve 8000.

FIG. 19( b) is a side cross-sectional view of a portion of the sleeve8000, according to one embodiment of the present invention. In thisembodiment, the closure elements 8020 and 8022 are shown to be taperedso as to form a shape similar to a “duck bill”. It should be recognizedthat the closure elements of the sleeve 8000 may have any suitable shapethat provides eased insertion of the surgical attachment 100 into theoral passage. FIG. 19( b) illustrates the closure elements 8020 and 8022in the closed position, in which the sleeve 8000 is suitable forinsertion into the oral passage. When the closure elements 8020 and 8022are in the closed position, as shown, the tapered arrangement of theclosure elements 8020 and 8022 enable the sleeve 8000, and the surgicalattachment 100 which is covered thereby, to be more easily inserted intothe oral passage, thereby reducing the likelihood of injury to aninternal surface of the oral passage. In one embodiment, the closureelements 8020 and 8022 may be maintained in the closed position byattachment to a portion of the surgical attachment 100, for instance byattachment to a trocar such as trocar 110 shown and described inconnection with FIG. 1.

FIG. 19( c) illustrates the closure elements 8020 and 8022 in the openposition. Specifically, after the sleeve 8000 has been inserted into theoral passage, the closure elements 8020 and 8022 may be opened so as topermit the surgical attachment 100 within the sleeve 8000 to perform adesired surgical operation. For instance, the closure elements 8020 and8022 may be opened so as to permit the anvil assembly 112 to beconnected to, then retracted towards and against, the staple and bladeportion 106.

In order to open the closure elements 8020 and 8022, the distal portion8024 and/or the closure elements 8020 and 8022 may have a retractionmechanism. For instance, FIG. 19( a) illustrates flaps 8028 that arepart of or that extend from the distal portion 8024 of the sleeve 8000.These flaps 8028 may be connected to the closure elements 8020 and 8022,such as by being laminated thereto or by insertion throughcircumferentially-disposed slots 8030 of the closure elements 8020 and8022. Thus, after the sleeve 8000 has been inserted into the oralpassage, the sleeve 8000 may be moved relative to the surgicalattachment 100 in a proximal direction. Movement of the sleeve 8000relative to the surgical attachment 100 in the proximal direction causesthe closure elements 8020 and 8022 to be pivoted or opened.

Depending on the size and shape of the sleeve 8000 and the surgicalattachment 100, once the closure elements 8020 and 8022 are opened, thesleeve 8000 may be left in place. In this case, the sleeve 8000 maysubsequently be employed, e.g., after the surgical procedure has beencompleted, to facilitate the removal the surgical attachment 100 fromthe oral passage. Alternatively, once the closure elements 8020 and 8022are opened, the sleeve 8000 may be removed from the oral passage—whilethe surgical attachment 100 remains in the oral passage—by continuedmovement of the sleeve 8000 relative to the surgical attachment 100 inthe proximal direction. In this case, the sleeve 8000, including theclosure element 8020 and 8022 are caused to slide over the surgicalattachment 100. While the flaps 8028 are shown in FIG. 19( a) as beingstraight in the longitudinal direction, in other embodiments, the flapsmay have a different shape, e.g., hooks, loops, etc.

FIGS. 19( d) and 19(e) illustrate a sleeve 8100, according to anotherembodiment of the present invention. Specifically, FIG. 19( d)illustrates the sleeve 8100 in an insertion position. In the insertionposition, the sleeve 8100 is configured so as to cover the surgicalattachment 100, and to provide eased insertion of the surgicalattachment 100 into the oral passage.

The sleeve 8100 may include a distal portion 8105. The distal portion8105 may be configured to cover a distal portion of the surgicalattachment 100, e.g., the staple and blade portion 106. The sleeve 8100may also include a proximal portion 8107. The proximal portion 8107 maybe configured to cover a proximal portion of the surgical attachment 100or any other components that are connected to the surgical attachment100. For instance, the proximal portion 8107 of the sleeve 8000 may beconfigured to cover a flexible shaft, e.g., the flexible shaft 20 or theflexible shaft 104 that are shown and described in connection with FIG.1, or a handle portion, e.g., the handle portion 102 that is shown anddescribed in connection with FIG. 7( a) or the handle portion 5102 thatis shown and described in connection with FIG. 13( a).

The sleeve 8100 may also include a closure element. The closure elementmay be configured as a ring 8102, although other shapes may be employed.When the sleeve 8100 is in the insertion position, the ring 8102 may bepositioned such that an axis 8104 that is defined by the ring 8102 issubstantially perpendicular to a longitudinal axis 8106 defined by thestaple and blade portion 106. The ring 8102 may be maintained in thisposition by attachment to a portion of the surgical attachment 100,e.g., by attachment to the trocar 110 extending through the staple andblade portion 106. In this position, one side 8110 of the ring 8102 isin contact with the distal side of the staple and blade portion 106, andthe opposite side 8112 of the ring 8102 is positioned opposite to thestaple and blade portion 106. The round outer circumference of the ring8102 provides a generally curved surface which, upon insertion into theoral passage, gradually opens the oral passage before the surgicalattachment 100 passes therethrough. In this manner, there is providedeased insertion of the surgical attachment 100 into the oral passage.

FIG. 19( e) illustrates the ring 8102 in the retracted position.Specifically, after the sleeve 8100, having the surgical attachment 100therein, has been inserted into the oral passage, the ring 8102 may bemoved relative to the surgical attachment 100 so as to permit thesurgical attachment 100 to perform its desired surgical operation. Forinstance, the ring 8102 may be rotated relative to axis 8109 so as topermit the anvil assembly 112 to be connected to and then retractedtowards the staple and blade portion 106. In order to retract the ring8102, the sleeve 8100 may be moved relative to the surgical attachment100 in a proximal direction. Movement of the sleeve 8100 relative to thesurgical attachment 100 in the proximal direction causes the ring 8102to be detached from, e.g., the trocar 100 of, the surgical attachment100 and to be drawn towards and against the staple and blade portion106. Continued movement of the sleeve 8100 relative to the surgicalattachment 100 in the proximal direction causes the ring 8102 to rotateand eventually be positioned such that the axis 8104 defined by the ring8102 becomes coaxial with the axis 8106 defined by the staple and bladeportion 106. In this position, the ring 8102 may, if its outer diameteris less than the outer diameter of the staple and blade portion 106,contact the staple and blade portion 106 with its entire circumferenceas illustrated in FIG. 19( e). Thus, the sleeve 8100 may continuecovering the staple and blade portion 106 during the surgical operationand may subsequently be employed, e.g., after the surgical procedure hasbeen completed, to facilitate the removal the surgical attachment 100from the oral passage. Alternatively, if the outer diameter of the ring8102 is greater than the outer diameter of the staple and blade portion106, continued movement of the sleeve 8100 relative to the surgicalattachment may cause the ring 8102 to slide over the surgical attachment100 for removal of the sleeve 8100 from the oral passage.

Thus, the several aforementioned objects and advantages of the presentinvention are most effectively attained. Those skilled in the art willappreciate that numerous modifications of the exemplary embodimentdescribed hereinabove may be made without departing from the spirit andscope of the invention. Although a single exemplary embodiment of thepresent invention has been described and disclosed in detail herein, itshould be understood that this invention is in no sense limited therebyand that its scope is to be determined by that of the appended claims.

1-27. (canceled)
 28. A surgical device for at least one of cutting andstapling a section of tissue, comprising: a housing forming a firstclamping surface; an anvil mechanically attachable and moveable relativeto the housing along an axis between an extended position and aretracted position, the anvil forming a second clamping surface, whereinat least a portion of the first and second clamping surfaces arenon-perpendicular relative to the axis.
 29. The surgical device of claim28, wherein, when the anvil is in the closed position, the surgicaldevice is configured to clamp a section of tissue between the first andsecond clamping faces.
 30. The surgical device of claim 29, wherein thefirst and second clamping faces are parallel relative to each other. 31.The surgical device of claim 30, further comprising a first driverconfigured to move the anvil relative to the housing.
 32. The surgicaldevice of claim 31, further comprising: a second driver, wherein thehousing includes a cutting element configured to be driven between aretracted position and an extended position by the second driver. 33.The surgical device of claim 31, further comprising: a second driver,wherein the housing includes a stapling element configured to be drivenbetween a retracted position and an extended position by the seconddriver.
 34. The surgical device of claim 28, wherein the staplingelement includes a staple cartridge.
 35. The surgical device of claim34, wherein the staple cartridge defines the second clamping face. 36.The surgical device of claim 35, wherein the staple element includes astaple pusher configured to push staples that are stored withinrespective slots of the staple cartridge out of the slots and againstthe anvil.
 37. The surgical device of claim 36, wherein the staplepusher includes at least two radially-spaced rows of staple pusherfingers, each row arranged at a different axial position.
 38. Thesurgical device of claim 37, wherein the slots of the staple cartridgedefine openings in the first clamping face, the openings being arrangedin at least two radially-spaced rows aligned with the at least tworadially-spaced rows of staple pusher fingers, each row of the openingsbeing arranged at a different axial position.
 39. The surgical device ofclaim 38, wherein the second clamping face defines staple guidesconfigured to close a staple, the staple guides being arranged in atleast two radially-spaced rows aligned with the at least tworadially-spaced rows of staple pusher fingers, each row of the stapleguides being arranged at a different axial position.
 40. The surgicaldevice of claim 39, wherein the first and second drivers are attachableto respective rotatable drive shafts, the rotatable drive shaftsselectively rotated by at least one motor. 41-105. (canceled)